Displaying 1 - 7 of 7
| 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 | 2551C | FLEET ENEMA ADULT 7G | 19G (FLE/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHATE | 133ML | A | 2.23 | 7G|19G | 2 | 2022-04-01 | 2024-03-31 | 6 | ||||
| 41 | 2551C | FLEET ENEMA ADULT 7G|19G ENEMA (FLE) SODIUM BIPHOSPHATE|SODI | 133ML | A | 2.9358 | 7G|19G | 2 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 41 | 2551E | QC ENEMA ADULT 7G|19G ENEMA (QUC) SODIUM BIPHOSPHATE|SODIUM | 133ML | A | 3.561 | 7G|19G | 2 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 40 | 2551F | ENEMA-LAX ADULT 7G | 19G ENEMA (LAF/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHATE | 133ML | A | 3.89 | 7G|19G | 2 | 2022-04-01 | 2024-03-31 | Change Local Agent | 6 | |||
| 40 | 25527 | FLEET ENEMA PAED 3.5G | 9.5G (FLE/AHI) SODIUM | 66ML | B | 5.79 | 9.5G|3.5G | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | 25527 | FLEET ENEMA PAED 3.5G|9.5G (FLE) SODIUM | 66ML | A | 3.262 | 9.5G|3.5G | 2 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 40 | 25528 | ENEMA-LAX CHILD 9.5G | 3.5G ENEMA (LAF/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHAT More ... | 66ML | A | 3.89 | 9.5G|3.5G | 2 | 2022-04-01 | 2024-03-31 | Change Local Agent | 6 | |||