Displaying 1 - 12 of 12
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 3261B VIDENE ANTISEPTIC 1% SOLN (ECO/COL) POVIDONE 500ML B 0.03 1% 0 2022-04-01 2024-03-31 0
40 3261S POVIDONE IODINE 1% SOLN (RIM/PHA) 16OZ B 0.0422 1% 2023-03-20 2024-03-31 No No Add to Contract as Cat B
40 3261U POVIDONE IODINE 1% SOLN (RYV/ATB) 500ML B 0.02 1% 0 2022-04-01 2022-07-12 0
40 3261U POVIDONE IODINE 1% SOLN (RYV/ATB) 500ML B 0.02 1% 0 2022-07-13 2024-03-31 Price Change 0
41 3261U POVIDONE IODINE 1% SOLN (RYV) (B) 500ML B 0.027 1% 500 2024-04-01 2024-06-18 6
41 3261U POVIDONE IODINE 1% SOLN (RYV) (B) 500ML B 0.022 1% 500 2024-06-19 2026-03-31 6
41 3261W POVIDONE IODINE 1% SOLN (CAR) POVIDONE IODINE (C) 500ML C 0.0432 1% 500 2024-04-01 2026-03-31 6
41 3261Z POVIDONE IODINE 1% SOLN (FSB) (B) 1 LITRE B 0.0207 1% 500 2024-04-01 2026-03-31 6
41 3262B POVIDONE IODINE SURGICAL 0.75% SCRUB (RIM) 1 GAL B 0.0216 0.75% 500 2024-04-01 2026-03-31 6
40 3262E VIDENE SURGICAL SCRUB 0.75% (ECO/COL) POVIDO 500ML B 0.03 0.75% 0 2022-04-01 2024-03-31 0
40 3262H POVIDONE IODINE 0.75% SCRUB (CHC/ATB) 500ML B 0.02 0.75% 0 2022-04-01 2024-03-31 0
40 3262J POVIDONE IODINE 0.75% SCRUB (CHC/ATB) DISPENSER 500ML B 0.02 0.75% 0 2022-04-01 2024-03-31 0