Displaying 1 - 15 of 15
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 2961AB LANOSTERONE 5MG TAB (LDP/AHI) NORETHISTERONE 100'S A 0.12 5MG 90 2022-04-01 2022-09-30 6
40 2961AC NORETHISTERONE 5MG TAB (RYV/ATB) 100'S A 0.07 5MG 90 2022-04-01 2022-07-26 6
40 2961AC NORETHISTERONE 5MG TAB (RYV/ATB) 100'S A 0.08 5MG 90 2022-09-27 2024-03-31 Price Change 6
40 2961AD NORETHISTERONE 5MG TAB (HEA/ATB) 10X10 A 0.0807 5MG 2022-12-07 2024-03-31 No No Change Local Agent 6
41 2961AD NORETHISTERONE 5MG TAB (HEA) 10X10 A 0.0835 5MG 90 2024-04-01 2026-03-31 6
42 2961AE NORESTH EZE 5MG TAB (INF) NORETHISTERONE 10X10 A 0.08 5MG 90 2026-04-01 No No 6
42 2961AF NORETHISTERONE 5MG TAB (HEA) 10X10 A 0.08 5MG 90 2026-04-01 No No Price Change 6
42 2961AH NORETHISTERONE 5MG TAB (HEA) 10X10 A 0.08 5MG 90 2026-04-01 No No Add to Contract as Cat A 6
42 2961AJ NORETHISTERONE 5MG TAB (HEA) 10X10 A 0.08 5MG 90 2026-04-01 No No Add to Contract as Cat A 6
40 2961K NORCOLUT 5MG TAB (CHW/AHI) NORETHISTERONE 2X10 A 0.16 5MG 90 2022-04-01 2022-09-30 6
41 2961K NORCOLUT 5MG TAB (CHW) NORETHISTERONE (C) 2X10 C 0.1726 5MG 90 2024-04-01 2026-03-31 6
42 2961S NORETHISTERONE 5MG TAB (REM) 3X10 A 0.08 5MG 90 2026-04-01 No No 6
40 2961V NORETHISTERONE 5MG TAB (HEA/RXP) 10X10 A 0.08 5MG 90 2022-04-01 2024-03-31 6
40 2961Z NORETHISTERONE 5MG TAB (KWA/ATB) 100'S A 0.08 5MG 90 2022-04-21 2022-09-30 6
41 2961Z NORETHISTERONE 5MG TAB (KWA) 100'S A 0.097 5MG 90 2024-04-01 2026-03-31 6