Displaying 1 - 20 of 20
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 16617 APO-OLANZAPINE 2.5MG TAB (APO/COL) 100'S BP 0.28 2.5MG 0 2022-04-01 2024-03-31 0
40 1661J OLANZAPINE 2.5MG TAB (MCP/AHI) 30'S BP 0.11 2.5MG 0 2022-04-01 2024-03-31 6
41 1661J OLANZAPINE 2.5MG TAB (MCP) (BP) 30'S BP 0.116 2.5MG 84 2024-04-01 2026-03-31 6
41 1661M APO-OLANZAPINE 2.5MG TAB (APO) (BP) 100'S BP 0.2903 2.5MG 84 2024-04-01 2026-03-31 6
40 16624 ZYPREXA 5MG TAB (LIL/STO) OLANZAPINE 28'S C 5.77 5MG 0 2022-04-01 2024-03-31 0
41 16624 ZYPREXA 5MG TAB (LIL) OLANZAPINE (C) 28'S C 9.0889 5MG 84 2024-04-01 2026-03-31 6
40 16628 APO-OLANZAPINE 5MG TAB (APO/COL) 100'S BP 0.16 5MG 0 2022-04-01 2024-03-31 6
40 1662S OLANZAPINE 5MG TAB (MCP/AHI) 30'S BP 0.13 5MG 0 2022-04-01 2024-03-31 6
41 1662S OLANZAPINE 5MG TAB (MCP) (BP) 30'S BP 0.1296 5MG 84 2024-04-01 2026-03-31 6
41 1662V APO-OLANZAPINE 5MG TAB (APO) (BP) 100'S BP 0.1664 5MG 84 2024-04-01 2026-03-31 6
40 16631 APO-OLANZAPINE 7.5MG TAB (APO/COL) 100'S BP 0.60 7.5MG 0 2022-04-01 2024-03-31 0
40 1663C OLANZAPINE 7.5MG TAB (MCP/AHI) 30'S BP 0.15 7.5MG 0 2022-04-01 2024-03-31 6
41 1663C OLANZAPINE 7.5MG TAB (MCP) (BP) 30'S BP 0.1477 7.5MG 42 2024-04-01 2026-03-31 6
41 1663F APO-OLANZAPINE 7.5MG TAB (APO) (BP) 100'S BP 0.6081 7.5MG 42 2024-04-01 2026-03-31 6
40 16646 ZYPREXA 10MG TAB (LIL/STO) OLANZAPINE 28'S C 10.34 10MG 0 2022-04-01 2024-03-31 0
41 16646 ZYPREXA 10MG TAB (LIL) OLANZAPINE (C) 28'S C 16.6536 10MG 42 2024-04-01 2026-03-31 6
40 1664A APO-OLANZAPINE 10MG TAB (APO/COL) 100'S BP 0.30 10MG 0 2022-04-01 2024-03-31 6
40 1664U OLANZAPINE 10MG TAB (MCP/AHI) 30'S BP 0.19 10MG 0 2022-04-01 2024-03-31 6
41 1664U OLANZAPINE 10MG TAB (MCP) (BP) 30'S BP 0.1975 10MG 42 2024-04-01 2026-03-31 6
41 1664Z APO-OLANZAPINE 10MG TAB (APO) (BP) 100'S BP 0.3028 10MG 42 2024-04-01 2026-03-31 6