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 B041JH PANTOPRAZOLE 20MG TAB (KWA/ATB) 10X10 C 0.09 20MG 0 2022-04-01 2024-03-31 0
40 B041LH PANTOPRAZOLE 40MG TAB (KWA/ATB) 100'S C 0.09 40MG 0 2022-04-01 2024-03-31 0
41 B041LS PROTON-P 20MG TAB (ARP) PANTOPRAZOL (C) 60'S C 0.159 20MG 0 2024-04-01 2026-03-31 0
41 B041NR APO-PANTOPRAZOLE 40MG TAB (APO) (C) 100'S C 0.1411 40MG 7 2024-04-01 2026-03-31 0
40 B0427 PANTOPRAZOLE 40MG INJ (CIP/AHI) 40MG VIAL B 2.61 40MG 0 2022-04-01 2022-09-30 0
41 B042AN PANTOPRAZOLE 40MG INJ (FSB) (B) 40MG VIAL B 1.1417 40MG 7 2024-04-01 2026-03-31 0
40 B042AV PANSALVE 40MG INJ (EMC/COL) PANTOPRAZOLE 40MG VIAL B 1.17 40MG 0 2022-04-01 2024-03-31 0
40 B042BL NEXIUM 40MG INJ (AZN/COL) PANTOPRAZOLE 5ML VIAL C 14.68 40MG 0 2022-05-04 2024-03-31 Package Size Change 0
41 B042BL NEXIUM 40MG INJ (AZN) PANTOPRAZOLE (B) 5ML VIAL B 14.3528 40MG 7 2024-04-01 2026-03-31 0
41 B042BX LASPRAZOLE 40MG INJ (LDP) PANTOPRAZOLE (B) 10X10ML B 2.6748 40MG 7 2024-04-01 2026-03-31 0