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 3582B SODIUM BICARBONATE 8.4% INJ (BRA/COL) 100ML B 6.50 8.4% 0 2022-04-01 2024-03-31 0
41 3582B SODIUM BICARBONATE 8.4% INJ (BRA) (B) 100ML B 6.9589 8.4% 70 2024-04-01 2026-03-31 0
42 3582B SODIUM BICARBONATE 8.4% INJ (BRA) 100ML B 9.51 8.4% 70 2026-04-01 No No 0
41 3582F SODIUM BICARBONATE 8.4% INJ (KWA) (B) 50ML B 4.4037 8.4% 70 2024-04-01 2026-03-31 0
42 3582G SODIUM BICARBONATE 8.4% INJ (KWA) 50ML B 5.03 8.4% 70 2026-04-01 No No Add to Contract as Cat B 0
40 35831 SODIUM BICARBONATE 8.4% INJ (FSB/ATB) 10ML B 1.14 8.4% 0 2022-04-01 2024-03-31 0
41 35831 SODIUM BICARBONATE 8.4% INJ (FSB) 10ML B 1.1961 8.4% 70 2024-04-01 2026-03-31 0
42 35833 SODIUM BICARBONATE 8.4% INJ (FSB) 10ML B 1.09 8.4% 70 2026-04-01 No No Add to Contract as Cat B 0
42 35861 SODIUM BICARBONATE 4.2% INJ (MTP) 10X10ML B 10.34 4.2% 0 2026-04-01 No No 0