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 06319 METHOTREXATE 2.5MG TAB (REM/SBI) 10X10 A 0.15 2.5MG 32 2022-04-01 2024-03-31 6
40 0631AD METHOTREXATE 2.5MG TAB (INP/AHI) 100'S A 0.13 2.5MG 32 2022-04-01 2024-03-31 6
41 0631AG ZUVITREX 2.5MG TAB (ZUV) METHOTREXATE 100'S A 0.1332 2.5MG 32 2024-04-01 2026-03-31 6
41 0631D METHOTREXATE 2.5MG TAB (REM) 100'S A 0.1479 2.5MG 32 2024-04-01 2026-03-31 6
40 0631Y METHOTREXATE 2.5MG TAB (FSB/ATB) 100'S A 0.07 2.5MG 32 2022-04-01 2022-09-30 6
40 0633V METHACOR 25MG/ML INJ (INP/AHI) METHOTREXATE 2ML VIAL B 8.70 25MG/ML 0 2022-04-01 2024-03-31 0
40 0633X UNITREXATE 25MG/ML INJ (UBI/RXP) METHOTREXATE 2ML VIAL B 7.07 25MG/ML 0 2022-04-01 2024-03-31 0
41 0633Z ZUVITREX 25MG/ML INJ (ZUV) METHOTREXATE (B) 2ML VIAL B 5.1104 25MG/ML 5 2024-04-01 2026-03-31 6
40 0634M METHOTREXATE 25MG/ML INJ (INP/AHI) 20ML VIAL BQ 46.43 25MG/ML 0 2022-04-01 2024-03-31 0
40 06351 METHOTREXATE 25MG/ML INJ (INP/AHI) 40ML BQ 82.12 25MG/ML 0 2022-04-01 2024-03-31 0