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
41 51516 ZIPRASIDONE 20MG CAP (DRL) (BP) 60'S BP 0.7072 20MG 84 2024-04-01 2026-03-31 6
40 51527 ZIPRASIDONE 40MG CAP (DRL/AHI) 60'S BP 1.35 40MG 0 2022-04-01 2024-03-31 6
41 51527 ZIPRASIDONE 40MG CAP (DRL) 60'S BP 1.3537 40MG 84 2024-04-01 2026-03-31 6
40 51535 ZIPRASIDONE 60MG CAP (DRL/AHI) 60'S BP 1.72 60MG 0 2022-04-01 2024-03-31 6
41 51535 ZIPRASIDONE 60MG CAP (DRL) 60'S BP 1.7239 60MG 84 2024-04-01 2026-03-31 6
40 51546 ZIPRASIDONE 80MG CAP (DRL/AHI) 60'S BP 2.09 80MG 0 2022-04-01 2024-03-31 6
41 51546 ZIPRASIDONE 80MG CAP (DRL) (BP) 60'S BP 2.0868 80MG 84 2024-04-01 2026-03-31 6
40 51554 ZIPRASIDONE 20MG INJ (DRL/AHI) 10X1ML BP 125.93 20MG 0 2022-04-01 2024-03-31 Package Size Change 0
41 51554 ZIPRASIDONE 20MG INJ (DRL) (BP) 10X1ML BP 125.8584 20MG 84 2024-04-01 2026-03-31 6