Displaying 1 - 20 of 26
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 19311 VIAGRA 100MG TAB (PFI/STO) SILDENAFIL 1'S C 16.96 100MG 0 2022-04-01 2024-03-31 0
41 19311 VIAGRA 100MG TAB (PFI) SILDENAFIL (C) 1'S C 17.5332 100MG 30 2024-04-01 2026-03-31 6
40 19312 VIAGRA 100MG TAB (PFI/STO) SILDENAFIL 4'S C 13.86 100MG 0 2022-04-01 2024-03-31 0
41 19312 VIAGRA 100MG TAB (PFI) SILDENAFIL (C) 4'S C 14.3392 100MG 30 2024-04-01 2026-03-31 6
40 19313 VIAGRA 100MG TAB (PFI/SBI) SILDENAFIL 1'S C 16.96 100MG 0 2022-04-01 2024-03-31 0
41 19313 VIAGRA 100MG TAB (PFI) SILDENAFIL (C) 1'S C 17.5332 100MG 30 2024-04-01 2026-03-31 6
40 19314 VIAGRA 100MG TAB (PFI/SBI) SILDENAFIL 4'S C 13.86 100MG 0 2022-04-01 2024-03-31 0
41 19314 VIAGRA 100MG TAB (PFI) SILDENAFIL (C) 4'S C 14.3392 100MG 30 2024-04-01 2026-03-31 6
41 1931AM SILDENAFIL 100MG TAB (RYV) (BQ) 4'S BQ 0.6592 100MG 30 2024-04-01 2026-03-31 6
40 1931AP SILDENAFIL 100MG TAB (MCP/AHI) 4'S BQ 0.38 100MG 0 2022-04-01 2024-03-31 6
41 1931AX MYGRA 100MG TAB (SKH) SILDENAFIL (BQ) 4'S BQ 0.3466 100MG 30 2024-04-01 2026-03-31 6
41 1931S XCITE 100MG TAB (GPC) SILDENAFIL (BQ) 4'S BQ 0.299 100MG 30 2024-04-01 2026-03-31 6
40 19321 VIAGRA 50MG TAB (PFI/STO) SILDENAFIL 1'S C 16.04 50MG 0 2022-04-01 2024-03-31 0
41 19321 VIAGRA 50MG TAB (PFI) SILDENAFIL (C) 1'S C 16.5818 50MG 30 2024-04-01 2026-03-31 6
40 19322 VIAGRA 50MG TAB (PFI/STO) SILDENAFIL 4'S C 14.16 50MG 0 2022-04-01 2024-03-31 0
41 19322 VIAGRA 50MG TAB (PFI) SILDENAFIL (C) 4'S C 14.645 50MG 30 2024-04-01 2026-03-31 6
40 19323 VIAGRA 50MG TAB (PFI/SBI) SILDENAFIL 1'S C 16.04 50MG 0 2022-04-01 2024-03-31 0
41 19323 VIAGRA 50MG TAB (PFI) SILDENAFIL (C) 1'S C 16.5818 50MG 30 2024-04-01 2026-03-31 6
40 19324 VIAGRA 50MG TAB (PFI/SBI) SILDENAFIL 4'S C 14.16 50MG 0 2022-04-01 2024-03-31 0
41 19324 VIAGRA 50MG TAB (PFI) SILDENAFIL (C) 4'S C 14.645 50MG 30 2024-04-01 2026-03-31 6