Displaying 1 - 18 of 18
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 0081T FLUCONAZOLE 200MG INJ (BRA/COL) 100ML BQ 4.9202 200MG 0 0
40 0081T FLUCONAZOLE 200MG INJ (BRA/COL) 100ML BQ 4.65 200MG 0 2022-04-01 2024-03-31 0
41 58615 DIFLUCAN 150MG CAP (PFI/STO) FLUCONAZOLE 1'S C 22.9155 150MG 60 6
40 58615 DIFLUCAN 150MG CAP (PFI/STO) FLUCONAZOLE 1'S C 22.70 150MG 0 2022-04-01 2024-03-31 0
40 5861AD APO-FLUCONAZOLE 50MG TAB (APO/COL) 50'S A 0.46 50MG 60 2022-04-01 2024-03-31 6
41 5861CF DILAPAN 150MG TAB (REM/SBI) FLUCONAZOLE 3'S C 0.9061 150MG 60 6
40 5861EG FLUCESS 150MG CAP (BCH/COL) FLUCONAZOLE 10'S C 1.12 150MG 0 2022-04-01 2024-03-31 0
40 5861EH FLUCESS 200MG CAP (BCH/COL) FLUCONAZOLE 10'S C 2.10 200MG 0 2022-04-01 2024-03-31 Price Change 0
40 5861ET FLUCONAZOLE 150MG CAP (HEA/RXP) 1'S A 0.46 150MG 60 2022-04-01 2024-03-31 6
41 5861HF FLUCESS 150MG CAP (BCH/COL) FLUCONAZOLE 1'S C 6.9045 150MG 60 6
40 5861JH FLUCONAZOLE 150MG TAB (LDP/AHI) 100'S A 0.24 150MG 60 2022-04-01 2024-03-31 6
40 5861JW FLUCONAZOLE 200MG TAB (FSB/ATB) 10'S A 0.36 200MG 60 2022-04-01 2024-03-31 Add to Contract as Cat A 6
41 5861KH FLUCONA-DENK 150MG CAP (EDK/SBI) FLUCONAZOLE 10'S A 0.2039 150MG 60 6
41 5861KQ CANEX 150MG TAB (TPP/AHI) FLUCONAZOLE 25'S A 0.1403 150MG 60 6
41 5861KS FLUCONAZOLE 100MG TAB (MCP/AHI) 10X10 A 0.233 100MG 60 6
41 5861KT FLUCONAZOLE 150MG TAB (MCP/AHI) 10X10 A 0.233 150MG 60 6
41 5861KU FLUCONAZOLE 200MG TAB (MCP/AHI) 10X10 A 0.233 200MG 60 6
40 5861Q APO-FLUCONAZOLE 100MG TAB (APO/COL) 50'S A 0.58 100MG 60 2022-04-01 2024-03-31 6