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 A322AA APO-SERTRALINE 50MG CAP (APO/COL) 100'S A 0.12 50MG 30 2022-04-01 2024-03-31 6
40 A322AF ZOLOFT 50MG TAB (PFI/STO) SERTRALINE 14'S C 1.39 50MG 0 2022-04-01 2024-03-31 0
41 A322AF ZOLOFT 50MG TAB (PFI) SERTRALINE (C) 14'S C 1.4058 50MG 42 2024-04-01 2026-03-31 6
40 A322AY ZOLOFT 100MG TAB (PFI/STO) SERTRALINE 14'S C 2.09 100MG 0 2022-04-01 2024-03-31 0
41 A322AY ZOLOFT 100MG TAB (PFI) SERTRALINE (C) 14'S C 2.1067 100MG 42 2024-04-01 2026-03-31 6
40 A322CJ APO-SERTRALINE 100MG CAP (APO/COL) 100'S A 0.19 100MG 30 2022-04-01 2024-03-31 6
40 A322CL ZOLOFT 100MG TAB (PFI/SBI) SERTRALINE 14'S C 2.09 100MG 0 2022-04-01 2024-03-31 0
41 A322CL ZOLOFT 100MG TAB (PFI) SERTRALINE (C) 14'S C 2.1067 100MG 42 2024-04-01 2026-03-31 6
40 A322CM ZOLOFT 50MG TAB (PFI/SBI) SERTRALINE 14'S C 1.39 50MG 0 2022-04-01 2024-03-31 0
41 A322CM ZOLOFT 50MG TAB (PFI) SERTRALINE (C) 14'S C 1.4058 50MG 42 2024-04-01 2026-03-31 6
41 A322LE APO-SERTRALINE 50MG CAP (APO) SERTRALINE 100'S A 0.1215 50MG 42 2024-04-01 2026-03-31 6
41 A322LF APO-SERTRALINE 100MG CAP (APO) 100'S A 0.1941 100MG 42 2024-04-01 2026-03-31 6