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 3653C NASASONE MF 50MCG NASAL SP (CAR/COL) MOMETASO 140 DOSES C 9.65 50MCG 0 2022-04-01 2024-03-31 0
41 3653C NASASONE MF 50MCG NASAL SP (CAR) MOMETAS 140 DOSES A 9.2423 50MCG 1 2024-04-01 2026-03-31 6
42 3653C NASASONE MF 50MCG NASAL SP (CAR) MOMETAS 140 DOSES C 9.24 50MCG 1 2026-04-01 No No 6
40 3653CK MOMETASONE 50MCG NASAL SP (BCH/COL) 140 DOSES A 9.08 50MCG 1 2022-04-01 2024-03-31 Add to Contract as Cat A 6
40 3653CT NASONEX 50MCG NASAL SP (MSD/STO) MOMETASONE 120 DOSES C 17.07 50MCG 0 2022-04-01 2024-03-31 0
41 3653CT NASONEX 50MCG NASAL SP (MSD) MOMETA (C) 120 DOSES C 17.2614 50MCG 1 2024-04-01 2026-03-31 6
42 3653CT NASONEX 50MCG NASAL SP (MSD) MOMET (C) 120 DOSES C 17.26 50MCG 1 2026-04-01 No No 6
41 3653CW APO-MOMETASONE 50MCG NASAL SP (APO) 140 DOSES A 7.8288 50MCG 1 2024-04-01 2026-03-31 6