Displaying 1 - 20 of 20
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 28411 GLYFORMIN 500MG TAB (REM/SBI) METFORMIN 100x10 A 0.04 500MG 180 2022-04-01 2024-03-31 6
42 28411 GLYFORMIN 500MG TAB (REM) METFORMIN 100x10 C 0.11 500MG 180 2026-04-01 No No 6
40 2841AK GLUCOPHAGE 500MG TAB (MEK/COL) METFORMIN 100'S C 0.08 500MG 0 2022-04-01 2024-03-31 0
41 2841AK GLUCOPHAGE 500MG TAB (MEK) METFORMIN (C) 100'S C 0.0796 500MG 180 2024-04-01 2026-03-31 6
42 2841AK GLUCOPHAGE 500MG TAB (MEK) METFORMIN 100'S A 0.09 500MG 180 2026-04-01 No No 6
41 2841AZ GLYFORMIN 500MG TAB (REM) METFORMIN 100X10 A 0.0661 500MG 180 2024-04-01 2026-03-31 6
41 2841DL ZOMET 500MG TAB (INP) METFORMIN 10X10 A 0.0408 500MG 180 2024-04-01 2026-03-31 6
42 2841DL ZOMET 500MG TAB (INP) METFORMIN 10X10 A 0.04 500MG 180 2026-04-01 No No 6
40 2841FA METFORMIN 500MG TAB (CAM/ATB) 84'S A 0.09 500MG 180 2022-04-01 2024-03-31 6
40 28422 GLUCOPHAGE 850MG TAB (MEK/COL) METFORMIN 100'S C 0.16 850MG 60 2022-08-25 2024-03-31 Add to Contract as Cat C 6
40 2842AC GLUCOPHAGE XR 750MG TAB (MEK/COL) METFORMIN 30'S C 0.91 750MG 0 2022-08-25 2024-03-31 Add to Contract as Cat C 0
40 2842C GLYFORMIN 850MG TAB (REM/SBI) METFORMIN 500'S A 0.06 850MG 90 2022-04-01 2024-03-31 6
41 2842C GLYFORMIN 850MG TAB (REM) METFORMIN 500'S A 0.1019 850MG 90 2024-04-01 2026-03-31 6
42 2842C GLYFORMIN 850MG TAB (REM) METFORMIN 500'S A 0.16 850MG 90 2026-04-01 No No 6
40 28433 GLUCOPHAGE 1G TAB (MEK/COL) METFORMIN 30'S C 0.55 1G 0 2022-04-01 2024-03-31 0
41 28433 GLUCOPHAGE 1G TAB (MEK) METFORMIN (C) 30'S C 0.5491 1G 90 2024-04-01 2026-03-31 6
40 28439 METFORMIN 1G TAB (APL/AHI) 100'S A 0.11 1G 90 2022-04-01 2024-03-31 Amend Protocol Quantity 6
41 2843BG METFORMIN-DENK 1G TAB (EDK) 30'S A 0.1377 1G 90 2024-04-01 2026-03-31 6
42 2843BG METFORMIN-DENK 1G TAB (EDK) 30'S A 0.16 1G 90 2026-04-01 No No 6
42 2843BJ METFORMIN-DENK 1G TAB (EDK) 2X15 A 0.16 1G 90 2026-04-01 No No 6