Displaying 1 - 14 of 14
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
41 23716 XYLOMETAZOLINE 0.1% NASAL DR (KWA) 15ML A 3.561 0.1% 1 2024-04-01 2026-03-31 0
40 23717 XYLOMETAZOLINE 0.1% NASAL DR (CIR/AHI) 10ML A 2.66 0.1% 1 2022-04-01 2022-09-30 0
40 2371E OTRIVINE 0.1% NASAL DR (GSK/COL) XYLOMETAZOLI 10ML A 5.79 0.1% 1 2022-04-01 2024-03-31 0
41 2371E OTRIVINE 0.1% NASAL DR (GSK) XYLOMETAZOL (C) 10ML C 6.089 0.1% 1 2024-04-01 2026-03-31 0
40 23728 OTRIVINE MDI 0.1% NASAL SP (GSK/COL) XYLOMETA 10ML C 4.38 0.1% 0 2022-04-01 2024-03-31 0
41 23728 OTRIVINE MDI 0.1% NASAL SP (GSK) XYLOMET (C) 10ML C 4.594 0.1% 1 2024-04-01 2026-03-31 0
40 2372K OTRIVINE 0.1% NASAL SP (GSK/COL) XYLOMETAZOLI 10ML C 4.78 0.1% 0 2022-04-01 2024-03-31 0
41 2372K OTRIVINE 0.1% NASAL SP (GSK) XYLOMETAZOL (C) 10ML C 5.0289 0.1% 1 2024-04-01 2026-03-31 0
41 2372T XYLOMETAZOLINE 0.1% NASAL SP (KWA) 10ML A 2.963 0.1% 1 2024-04-01 2026-03-31 0
40 2372U XYLOMETAZOLINE 0.1% NASAL SP (FSB/ATB) 10ML A 3.53 0.1% 1 2022-04-01 2024-03-31 0
40 23739 OTRIVINE 0.05% NASAL DR (GSK/COL) XYLOMETAZOL 10ML A 4.70 0.05% 1 2022-04-01 2024-03-31 0
41 23739 OTRIVINE 0.05% NASAL DR (GSK) XYLOMETAZO (C) 10ML C 4.9473 0.05% 1 2024-04-01 2026-03-31 0
41 2373E XYLOMETAZOLINE 0.05% NASAL DR (KWA) 15ML A 2.6096 0.05% 1 2024-04-01 2026-03-31 0
40 2373S XYLOMETAZOLINE 0.05% NASAL DR (CIR/AHI) 10ML A 2.31 0.05% 1 2022-04-01 2022-09-30 6