Displaying 1 - 6 of 6
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 0071G APO-ZOLPIDEM 5MG TAB (APO/COL) 30'S C 0.59 5MG 0 2022-04-01 2024-03-31 0
41 0071H APO-ZOLPIDEM 5MG TAB (APO) ZOLPIDEM 30'S C 0.6053 5MG 0 2024-04-01 2026-03-31 0
40 0072D ZOLPIDEM 10MG TAB (RYV/ALW) 30'S C 0.62 10MG 0 2022-04-01 2024-03-31 0
41 0072D ZOLPIDEM 10MG TAB (RYV) (C) 30'S C 0.6207 10MG 0 2024-04-01 2026-03-31 0
41 0072E APO-ZOLPIDEM 10MG TAB (APO) ZOLPIDE (C) 30'S C 0.6796 10MG 0 2024-04-01 2026-03-31 0
40 0072K APO-ZOLPIDEM 10MG TAB (APO/COL) 30'S C 0.67 10MG 0 2022-04-01 2024-03-31 0