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 3961AS EPILIM CHRONO 133.2MG | 58MG TAB (SFA/COL) SODI 30'S A 0.37 133.2MG|58MG 150 2022-04-01 2024-03-31 6
41 3961AS EPILIM CHRONO 133.2MG|58MG CR TAB (SFA) SODIUM VALPROATE|VAL 30'S A 0.367 133.2MG|58MG 150 2024-04-01 2026-03-31 6
40 39634 EPILIM CHRONO 199.8MG | 87MG TAB (SFA/COL) SODI 30'S A 0.50 199.8MG|87MG 150 2022-04-01 2024-03-31 6
41 39635 VALEX 199.8MG|87MG CR TAB (INC) SODIUM VALPROATE|VALPROIC AC 3X10 A 0.4387 199.8MG|87MG 90 2024-04-01 2026-03-31 6
40 3965A EPILIM CHRONO 333MG | 145M TAB (SFA/COL) SODIUM VALPROATE | VALPROIC ACID 30'S A 0.65 333MG|145MG 150 2022-04-01 2024-03-31 6
41 3965A EPILIM CHRONO 333MG|145MG CR TAB (SFA) SODIUM VALPROATE|VALP 30'S A 0.6515 333MG|145MG 120 2024-04-01 2026-03-31 6