Displaying 1 - 15 of 15
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 A321AH VENLAFAXINE ER 37.5MG TAB (APL/AHI) VENLAFAXI 30'S BP 0.36 37.5MG 0 2022-04-01 2024-03-31 6
40 A321S VENLAFAXINE SR 37.5MG CAP (CIP/AHI) 100'S BP 0.35 37.5MG 0 2022-04-01 2024-03-31 6
41 A322BT VENLAFAXINE 150MG SR TAB (CIP) (BP) 100'S BP 1.2575 150MG 0 2024-04-01 2026-03-31 0
41 A322BU VENLAFAXINE 75MG SR TAB (CIP) (BP) 100'S BP 0.6442 75MG 0 2024-04-01 2026-03-31 0
40 A322GA EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE 14'S C 4.84 150MG 0 2022-04-01 2022-08-23 Delete from contract 0
40 A322GB EFFEXOR XR 75MG CAP (PFI/STO) VENLAFAXINE 14'S C 4.84 75MG 0 2022-04-01 2022-08-23 Delete from contract 0
40 A322JV VENLAFAXINE SR 75MG CAP (APL/AHI) VENLAFAXINE 1000'S BP 0.52 75MG 0 2022-04-01 2022-09-30 6
40 A322JY VENLAFAXINE SR 150MG TAB (WAT/AHI) VENLAFAXIN 90'S BP 0.71 150MG 0 2022-04-01 2022-09-30 0
40 A322KE EFFEXOR XR 75MG CAP (PFI/SBI) VENLAFAXINE 14'S C 4.84 75MG 0 2022-04-01 2024-03-31 0
40 A322KR VENLAFAXINE ER 150MG CAP (APL/AHI) VENLAFAXIN 90'S BP 0.77 150MG 0 2022-04-01 2024-03-31 6
40 A322KS VENLAFAXINE ER 75MG CAP (APL/AHI) VENLAFAXINE 30'S BP 0.63 75MG 0 2022-04-01 2024-03-31 6
40 A322KV EFFEXOR XR 150MG CAP (PFI/SBI) VENLAFAXINE 14'S C 4.84 150MG 0 2022-04-01 2024-03-31 Price Change 0
40 A322KX EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE 28'S C 4.84 150MG 0 2022-07-12 2024-03-31 Package Size Change
40 A322KY EFFEXOR XR 75MG CAP (PFI/STO) VENLAFAXINE 28'S C 4.84 75MG 0 2022-07-12 2024-03-31 Package Size Change
41 A322KY EFFEXOR XR 75MG XR CAP (PFI) VENLAFAXINE (C) 28'S C 4.8862 75MG 0 2024-04-01 2026-03-31 0