Displaying 1 - 20 of 37
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 B1513 XARELTO 10MG TAB (BSP/AHI) RIVAROXABAN 10'S C 6.05 10MG 0 2022-04-01 2024-03-31 0
41 B1513 XARELTO 10MG TAB (BSP) RIVAROXABAN (C) 10'S C 6.0537 10MG 30 2024-04-01 2026-03-31 0
42 B1513 XARELTO 10MG TAB (BSP) RIVAROXABAN 10'S C 3.04 10MG 30 2026-04-01 No No 0
40 B1514 XARELTO 10MG TAB (BSP/COL) RIVAROXABAN 10'S C 6.05 10MG 0 2022-04-01 2024-03-31 0
41 B1514 XARELTO 10MG TAB (BSP) RIVAROXABAN (C) 10'S C 6.0537 10MG 30 2024-04-01 2026-03-31 0
42 B1514 XARELTO 10MG TAB (BSP) RIVAROXABAN 10'S C 2.77 10MG 30 2026-04-01 No No 0
41 B1517 XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C) 28'S C 3.0289 2.5MG 60 2024-04-01 2026-03-31 6
42 B1517 XARELTO 2.5MG TAB (BSP) RIVAROXABAN 28'S C 1.59 2.5MG 60 2026-04-01 No No 6
40 B151A XARELTO 2.5MG TAB (BSP/AHI) RIVAROXABAN 56'S C 3.03 2.5MG 0 2022-04-01 2024-03-31 0
41 B151A XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C) 56'S C 3.029 2.5MG 60 2024-04-01 2026-03-31 6
40 B151C XARELTO 2.5MG TAB (BSP/AHI) RIVAROXABAN 28'S C 3.03 2.5MG 0 2022-04-01 2024-03-31 0
41 B151C XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C) 28'S C 3.029 2.5MG 60 2024-04-01 2026-03-31 6
42 B151C XARELTO 2.5MG TAB (BSP) RIVAROXABAN 28'S C 3.04 2.5MG 60 2026-04-01 No No 6
42 B151Q APO-RIVAROXABAN 2.5MG TAB (APO) 60'S B 1.36 2.5MG 60 2026-04-01 No No 6
42 B151T PMS-RIVAROXABAN 10MG TAB (PMS) 100'S B 1.06 10MG 30 2026-04-01 2028-03-31 No No 0
40 B1523 XARELTO 15MG TAB (BSP/AHI) RIVAROXABAN 28'S C 6.07 15MG 0 2022-04-01 2024-03-31 0
41 B1523 XARELTO 15MG TAB (BSP) RIVAROXABAN (C) 28'S C 6.0687 15MG 30 2024-04-01 2026-03-31 0
42 B1523 XARELTO 15MG TAB (BSP) RIVAROXABAN 28'S C 3.04 15MG 30 2026-04-01 No No 0
40 B1525 XARELTO 15MG TAB (BSP/COL) RIVAROXABAN 28'S C 6.07 15MG 0 2022-04-01 2024-03-31 0
41 B1525 XARELTO 15MG TAB (BSP) RIVAROXABAN (C) 28'S C 6.0687 15MG 30 2024-04-01 2026-03-31 0