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 3681G NALOXONE 0.4MG/ML INJ (RTM/PHA) 10X1ML BQ 4.925 0.4MG/ML 2022-04-01 2024-03-31 No No Add to Contract as Cat B
41 3681G NALOXONE 0.4MG/ML INJ (RTM) (B) 10X1ML B 5.7302 0.4MG/ML 0 2024-04-01 2026-03-31 0
42 3681G NALOXONE 0.4MG/ML INJ (RTM) 10X1ML B 4.08 0.4MG/ML 0 2026-04-01 No No 0
41 3681Q N-XONE 0.4MG/ML INJ (VEV) NALOXONE (B) 10X1ML B 4.7299 0.4MG/ML 0 2024-04-01 2026-03-31 0
40 3681T NALOXONE 0.4MG/ML INJ (MON/PHA) 5X1ML BQ 2.71 0.4MG/ML 0 2022-04-01 2024-03-31 0
40 3681T NALOXONE 0.4MG/ML INJ (MON/PHA) 5X1ML BQ 2.708 0.4MG/ML 2023-03-20 2024-03-31 No No Delete from contract
42 3681T NALOXONE 0.4MG/ML INJ (MON) 5X1ML B 3.20 0.4MG/ML 0 2026-04-01 No No 0
40 3681V NALOXONE 0.4MG/ML AMP (RTM/PHA) 10'S 5.786 0.4MG/ML 2023-03-20 2024-03-31 No No Price Change
41 3681W NALOXONE 0.4MG/ML INJ (OMG) (B) 10X1ML B 4.7353 0.4MG/ML 0 2024-04-01 2026-03-31 0
42 3681W NALOXONE 0.4MG/ML INJ (OMG) 10X1ML B 5.22 0.4MG/ML 0 2026-04-01 No No 0