Displaying 1 - 16 of 16
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 15117 PHENYTOIN CHEW 50MG TAB (KWA/ATB) PHENYTOIN 10X10 A 0.49 50MG 180 2022-04-01 2024-03-31 6
40 15123 DILANTIN 100MG CAP (PFI/SBI) PHENYTOIN 100'S A 0.36 100MG 180 2022-04-01 2024-03-31 6
41 15123 DILANTIN 100MG CAP (PFI) PHENYTOIN 100'S A 0.3599 100MG 180 2024-04-01 2026-03-31 6
41 1512G PHENYTOIN 100MG CHEW TAB (KWA) 100'S A 0.1802 100MG 180 2024-04-01 2026-03-31 6
40 1512T DILANTIN 100MG CAP (PFI/STO) PHENYTOIN 100'S A 0.36 100MG 180 2022-04-01 2024-03-31 6
41 1512T DILANTIN 100MG CAP (PFI) PHENYTOIN 100'S A 0.3599 100MG 180 2024-04-01 2026-03-31 6
40 15132 DILANTIN 25MG/ML SUSP (PFI/SBI) PHENYTOIN 240ML A 0.26 25MG/ML 600 2022-04-01 2024-03-31 6
41 15132 DILANTIN 25MG/ML SUSP (PFI) PHENYTOIN 237ML A 0.2589 25MG/ML 600 2024-04-01 2026-03-31 6
40 15134 DILANTIN 25MG/ML SUSP (PFI/STO) PHENYTOIN 240ML A 0.26 25MG/ML 600 2022-04-01 2024-03-31 6
41 15134 DILANTIN 25MG/ML SUSP (PFI) PHENYTOIN 237ML A 0.2589 25MG/ML 600 2024-04-01 2026-03-31 6
40 1514M PHENYTOIN 50MG/ML INJ (MON/PHA) 5X5ML B 1.56 50MG/ML 0 2022-04-01 2022-07-18 0
40 1514M PHENYTOIN 50MG/ML INJ (MON/PHA) 5X5ML B 1.92 50MG/ML 0 2022-07-19 2024-03-31 Price Change 0
41 1514N EPAMIN 50MG/ML INJ (PFI) PHENYTOIN (C) 10X5ML C 36.591 50MG/ML 2 2024-04-01 2026-03-31 0
40 1514P EPAMIN 50MG/ML INJ (PFI/STO) PHENYTOIN 10X5ML C 36.26 50MG/ML 0 2022-04-01 2024-03-31 0
41 1514P EPAMIN 50MG/ML INJ (PFI) PHENYTOIN (C) 10X5ML C 36.5914 50MG/ML 2 2024-04-01 2026-03-31 0
41 1514R PHENYTOIN 50MG/ML INJ (STP) (B) 100X5ML B 3.262 50MG/ML 2 2024-04-01 2026-03-31 0