Displaying 1 - 9 of 9
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 60914 AAP-PENTOXIFYLLINE SR 400MG TAB (APO/COL) 100'S C 0.24 400MG 0 2022-04-01 2024-03-31 Name Change 0
42 60914 AAP-PENTOXIFYLLINE SR 400MG TAB (APO) 100'S A 0.22 400MG 90 2026-04-01 No No 6
40 60917 PENTOXIFYLLINE 400MG TAB (HEA/RXP) 10X10 A 0.21 400MG 90 2022-04-01 2024-03-31 6
41 6091B AAP-PENTOXIFYLLINE SR 400MG TAB (APO) 100'S A 0.1911 400MG 90 2024-04-01 2026-03-31 6
40 6091F PENTOXIFYLLINE 400MG TAB (KWA/ATB) 10X10 A 0.19 400MG 90 2022-04-01 2024-03-31 6
41 6091F PENTOXIFYLLINE 400MG TAB (KWA) 10X10 A 0.2357 400MG 90 2024-04-01 2026-03-31 6
40 6091G PENTOXIFYLLINE 400MG TAB (HEA/ATB) 10X10 A 0.2118 400MG 90 2022-07-12 2024-03-31 No No la 6
41 6091G PENTOXIFYLLINE 400MG TAB (HEA) 10X10 A 0.2751 400MG 90 2024-04-01 2026-03-31 6
42 6091L TRENTAL 400MG TAB (GRM) PENTOXIFYLLINE 2X10 C 1.35 400MG 90 2026-04-01 No No 6