Displaying 1 - 20 of 40
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 43519 BOTTLE, GLASS RX, 30ML AMBER EACH (BEA/COL) 130'S B 0.33 0 2022-04-01 2024-03-31 0
42 4351E BOTTLE, GLASS RX, 30ML AMBER 30ML (BEA) BOTTLES 110'S B 0.36 30ML 0 2026-04-01 No No 0
40 43528 BOTTLE, GLASS RX, 60ML AMBER EACH (BEA/COL) 132'S B 0.40 0 2022-04-01 2024-03-31 Price Change 0
41 43528 BOTTLE, GLASS RX, 60ML AMBER EACH (BEA) 132'S B 0.3985 4 2024-04-01 2025-01-28 0
41 4352A BOTTLE, GLASS RX, 60ML AMBER (BEA) BOTTLES 81'S B 0.3985 4 2024-12-17 2026-03-31
42 4352A BOTTLE, GLASS RX, 60ML AMBER (BEA) BOTTLES 81'S B 0.40 0 2026-04-01 No No 0
40 43536 BOTTLE, GLASS RX, 100ML FLAT (BEA/COL) BOT 90'S B 0.97 0 2022-04-01 2024-03-31 Price Change 0
41 43536 BOTTLE, GLASS RX, 100ML FLAT (BEA) 90'S B 0.8385 4 2024-04-01 2026-03-31 0
42 43536 BOTTLE, GLASS RX, 100ML FLAT (BEA) 90'S B 1.06 4 2026-04-01 No No 0
40 43539 BOTTLE, GLASS RX, 100ML AMBER (BEA/COL) BOT 104'S B 0.41 0 2022-04-01 2024-03-31 0
40 43544 BOTTLE, GLASS RX, 200ML AMBER (BEA/COL) BOT 67'S B 0.56 0 2022-04-01 2024-03-31 0
40 43545 BOTTLE, GLASS RX, 200ML FLAT (BEA/COL) BOTT 56'S B 0.67 0 2022-04-01 2024-03-31 0
41 43545 BOTTLE, GLASS RX, 200ML FLAT (BEA) (B) 56'S B 0.5995 4 2024-04-01 2026-03-31 0
41 43547 BOTTLE, GLASS RX, 200ML, AMBER 200ML (BEA) (B) 64'S B 0.8567 200ML 0 2024-04-01 2026-03-31 0
42 43547 BOTTLE, GLASS RX, 200ML, AMBER 200ML (BEA) 64'S B 0.78 200ML 0 2026-04-01 No No 0
40 43554 BOTTLE, GLASS RX, 500ML AMBER (BEA/COL) 35'S B 0.86 0 2022-04-01 2024-03-31 0
42 43555 BOTTLE, GLASS RX, 500ML AMBER (BEA) 25'S B 1.44 4 2026-04-01 No No 0
40 43574 BOTTLE, GLASS RX, 150ML AMBER (BEA/COL) BOT 84'S B 0.50 0 2022-04-01 2024-03-31 Price Change 0
41 43574 BOTTLE, GLASS RX, 150ML AMBER (BEA) 84'S B 0.4997 4 2024-04-01 2025-01-28 0
41 43579 BOTTLES, GLASS RX, 150ML AMBER (BEA) 81'S B 0.4998 4 2024-12-17 2026-03-31