Displaying 1 - 20 of 23
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 2841BM METFORMIN XR 500MG TAB (HEA/RXP) 10X10 A 0.07 500MG 120 2022-04-01 2022-12-07 DEL 6
40 2841BX METFORMIN XR 100'S A .0748 500MG 120 2022-12-07 2024-03-31 No No ADD AS CAT A BENEFIT 6
40 2841BX METFORMIN XR 500MG TAB (HEA/ATB) 10X10 A 0.0748 500MG 2022-12-07 2024-03-31 No No Change Local Agent 6
41 2841BX METFORMIN 500MG XR TAB (HEA) 10X10 A 0.0807 500MG 120 2024-04-01 2026-03-31 6
40 2841EZ METSAFE ER 500MG TAB (MSN/ATB) METFORMIN XR 10X10 A 0.05 500MG 120 2022-04-01 2024-03-31 6
41 2841FX METFORMIN 500MG XR TAB (BEX) 10X10 A 0.0748 500MG 120 2024-04-01 2026-03-31 6
41 2841GC LAFINE 500MG XR TAB (LDP) METFORMIN XR 500'S A 0.0698 500MG 120 2024-04-01 2024-06-06 6
41 2841GM METFOR-EZE 500MG ER TAB (INF) METFORMIN XR 100'S A 0.0748 500MG 120 2024-04-24 2026-03-31 6
42 2841GM METFOR-EZE 500MG XR TAB (INF) METFORMIN XR 100'S A 0.07 500MG 120 2026-04-01 No No 6
41 2841GN LAFINE 500MG XR TAB (LDP) METFORMIN XR 100'S A 0.0699 500MG 120 2024-04-25 2026-03-31 6
42 2841HD METFORMIN 500MG XR TAB (HEA) 10X10 A 0.08 500MG 120 2026-04-01 No No Price Change 6
42 2841HN METFORMIN 500MG XR TAB (HEA) 10X10 A 0.08 500MG 120 2026-04-01 No No Add to Contract as Cat A 6
42 2841HP METFORMIN 500MG ER TAB (HEA) 10X10 A 0.08 500MG 120 2026-04-01 No No Add to Contract as Cat A 6
40 2841T GLUCOPHAGE XR 500MG TAB (MEK/COL) METFORMIN X 30'S C 0.73 500MG 0 2022-04-01 2024-03-31 0
41 2841T GLUCOPHAGE 500MG XR TAB (MEK) METFORMIN XR (C) 30'S C 0.7249 500MG 120 2024-04-01 2026-03-31 6
42 2841T GLUCOPHAGE 500MG XR TAB (MEK) METFORMIN XR 30'S C 0.74 500MG 120 2026-04-01 No No 6
41 2842AC GLUCOPHAGE 750MG XR TAB (MEK) METFORMIN XR (C) 30'S C 0.9061 750MG 0 2024-04-01 2026-03-31 0
42 2842AC GLUCOPHAGE 750MG XR TAB (MEK) METFORMIN XR 30'S C 1.11 750MG 0 2026-04-01 No No 0
40 28432 GLUCOPHAGE XR 1G TAB (MEK/COL) METFORMIN XR 30'S C 1.09 1G 0 2022-04-01 2024-03-31 0
41 28432 GLUCOPHAGE 1G XR TAB (MEK) METFORMIN XR (C) 30'S C 1.0891 1G 0 2024-04-01 2026-03-31 6