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 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS PRENATAL 28'S C 0.50 0 2022-04-01 2022-09-30 0
40 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS + M (C) 28'S C 0.5321 2022-10-01 2023-02-20 No No Price Change 0
40 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS PRE (C) 28'S C 0.5475 2023-02-21 2024-03-31 No No Add to Contract as Cat C
41 35311 NATELE CAP (BSP) MULTIVITAMINS PRENATAL (C) 28'S C 0.4495 30 2024-04-01 2026-03-31 6
40 35313 VITAPLEX P CAP (CAR/COL) MULTIVITAMINS PRENATAL 400'S B 0.29 0 2022-04-01 2024-03-31 0
41 35313 VITAPLEX P CAP (CAR) MULTIVITAMINS PRENATAL (B) 400'S B 0.3041 30 2024-04-01 2026-03-31 6
40 35314 NATELE TAB (BSP/COL) MULTIVITAMINS PRENATAL 28'S C 0.53 0 2022-04-01 2024-03-31 0
41 35314 NATELE TAB (BSP) MULTIVITAMINS PRENATAL (C) 28'S C 0.4495 0 2024-04-01 2026-03-31 0