Displaying 1 - 8 of 8
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 A7512 SANDOSTATIN 0.1MG/ML INJ (NVS/COL) OCTREOTIDE 5X1ML BQ 34.90 0.1MG/ML 0 2022-04-01 2024-03-31 0
41 A7512 SANDOSTATIN 0.1MG/ML INJ (NVS) OCTREOTID (BQ) 5X1ML BQ 34.9033 0.1MG/ML 20 2024-04-01 2026-03-31 6
42 A7512 SANDOSTATIN 0.1MG/ML INJ (NVS) OCTREOTID 5X1ML BQ 34.90 0.1MG/ML 20 2026-04-01 No No 0
40 A7513 SANDOSTATIN LAR 20MG INJ (NVS/COL) OCTREOTIDE 20MG VIAL BQ 3,860.02 20MG 0 2022-04-01 2024-03-31 6
41 A7513 SANDOSTATIN LAR 20MG INJ (NVS) OCTREOTID (BQ) 20MG VIAL BQ 3860.0201 20MG 20 2024-04-01 2026-03-31 6
42 A7513 SANDOSTATIN LAR 20MG INJ (NVS) OCTREOTID 20MG VIAL BQ 3,860.02 20MG 20 2026-04-01 No No 0
40 A751D OCTREOTIDE 0.1MG/ML INJ (DIL/AHI) 10X1ML BQ 2.46 0.1MG/ML 0 2022-04-01 2024-03-31 0
41 A751L OCTREOTIDE 0.1MG/ML INJ (CHC) (BQ) 1ML AMP BQ 12.5043 0.1MG/ML 20 2024-04-01 2026-03-31 6