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 4331AB SUTENT 12.5MG TAB (PFI/STO) SUNITINIB 28'S C 123.35 12.5MG 0 2022-04-01 2024-03-31 0
41 4331AB SUTENT 12.5MG TAB (PFI) SUNITINIB (BQ) 28'S BQ 123.3527 12.5MG 0 2024-04-01 2026-03-31 6
42 4331AB SUTENT 12.5MG CAP (PFI) SUNITINIB 28'S C 123.35 12.5MG 0 2026-04-01 No No 6
40 4331AC SUTENT 25MG TAB (PFI/STO) SUNITINIB 28'S C 242.59 25MG 0 2022-04-01 2024-03-31 0
41 4331AC SUTENT 25MG TAB (PFI) SUNITINIB (BQ) 28'S BQ 242.5929 25MG 0 2024-04-01 2026-03-31 6
42 4331AC SUTENT 25MG CAP (PFI) SUNITINIB 28'S C 242.59 25MG 0 2026-04-01 No No 6
40 4331E SUTENT 50MG TAB (PFI/STO) SUNITINIB 28'S C 452.29 50MG 0 2022-04-01 2024-03-31 0
41 4331E SUTENT 50MG TAB (PFI) SUNITINIB (BQ) 28'S BQ 452.2913 50MG 0 2024-04-01 2026-03-31 6
42 4331E SUTENT 50MG CAP (PFI) SUNITINIB 28'S C 452.29 50MG 0 2026-04-01 No No 6