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 A6611 IMIGRAN 100MG TAB (GSK/COL) SUMATRIPTAN 2'S C 24.74 100MG 0 2022-04-01 2022-05-31 Delete from contract 0
40 A6612 IMIGRAN 50MG TAB (GSK/COL) SUMATRIPTAN 2'S C 16.96 50MG 0 2022-04-01 2022-05-31 Delete from contract 0
40 A661AX SUMATRIPTAN 100MG TAB (DRL/AHI) 27'S C 1.28 100MG 0 2022-04-01 2024-03-31 0
41 A661AY APO-SUMATRIPTAN 50MG TAB (APO) (C) 6'S C 0.7566 50MG 0 2024-04-01 2026-03-31 0
41 A661AZ APO-SUMATRIPTAN 100MG TAB (APO) (C) 6'S C 1.332 100MG 0 2024-04-01 2026-03-31 0
40 A661X APO-SUMATRIPTAN 50MG TAB (APO/COL) 6'S C 0.74 50MG 0 2022-04-01 2024-03-31 0
40 A661Y APO-SUMATRIPTAN 100MG TAB (APO/COL) 6'S C 1.31 100MG 0 2022-04-01 2024-03-31 0