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 A0411 CELLCEPT 500MG CAP (ROC/AHI) MYCOPHENOLATE 50'S BQ 3.81 500MG 0 2022-04-01 2024-03-31 6
41 A0411 CELLCEPT 500MG CAP (ROC) MYCOPHENOL (C) 50'S C 3.8057 500MG 180 2024-04-01 2026-03-31 6
40 A0412 MYFORTIC 360MG CAP (NVS/COL) MYCOPHENOLATE 120'S C 5.35 360MG 0 2022-04-01 2024-03-31 0
41 A0412 MYFORTIC 360MG CAP (NVS) MYCOPHENOLATE (C) 120'S C 5.346 360MG 240 2024-04-01 2026-03-31 6
41 A041L APO-MYCOPHENOLATE 500MG TAB (APO) (BQ) 50'S BQ 1.0205 500MG 180 2024-04-01 2026-03-31 0
41 A041N MYCOPHENOLATE 360MG TAB (INP) (C) 50'S C 4.4852 360MG 0 2024-04-01 2026-03-31 0
41 A041Q MOFILET 500MG TAB (EMC) MYCOPHENOLATE 60'S BQ 1.033 500MG 180 2024-04-01 2026-03-31 0
40 A0421 CELLCEPT 250MG CAP (ROC/AHI) MYCOPHENOLATE 100'S BQ 1.90 250MG 0 2022-04-01 2024-03-31 6
41 A0421 CELLCEPT 250MG CAP (ROC) MYCOPHENOL (C) 100'S C 1.9028 250MG 360 2024-04-01 2026-03-31 6
41 A042G APO-MYCOPHENOLATE 250MG CAP (APO) (BQ) 100'S BQ 0.5102 250MG 360 2024-04-01 2026-03-31 6