Displaying 1 - 20 of 20
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 72811 TOPAMAX 25MG TAB (JAC/STO) TOPIRAMATE 20'S C 0.91 25MG 0 2022-04-01 2024-03-31 0
41 72811 TOPAMAX 25MG TAB (JAC) TOPIRAMATE (C) 20'S C 0.9093 25MG 60 2024-04-01 2026-03-31 6
40 72812 APO-TOPIRAMATE 25MG TAB (APO/COL) 100'S BP 0.09 25MG 0 2022-04-01 2024-03-31 0
40 7281K NEUROTOPREL 25MG TAB (ABB/PHA) TOPIRAMATE 30'S C 0.67 25MG 0 2022-04-01 2024-03-31 0
40 7281K NEUROTOPREL 25MG TAB (ABB/PHA) TOPIRAMATE (C) 30'S C 0.6707 25MG 2022-04-01 2023-03-31 No No Delete from contract 0
41 7281L TOPIRAMATE 25MG TAB (CAM) (BP) 60'S BP 0.0829 25MG 60 2024-04-01 2026-03-31 6
40 72831 TOPAMAX 100MG TAB (JAC/STO) TOPIRAMATE 20'S C 2.93 100MG 0 2022-04-01 2024-03-31 0
41 72831 TOPAMAX 100MG TAB (JAC) TOPIRAMATE (C) 20'S C 2.9276 100MG 120 2024-04-01 2026-03-31 6
40 72833 APO-TOPIRAMATE 100MG TAB (APO/COL) 100'S BP 0.17 100MG 0 2022-04-01 2024-03-31 0
41 7283G TOPIRAMATE 100MG TAB (CIP) (BP) 60'S BP 0.1581 100MG 120 2024-04-01 2025-03-10 6
40 7283Q NEUROTOPREL 100MG TAB (ABB/PHA) TOPIRAMATE 30'S C 2.44 100MG 0 2022-04-01 2024-03-31 0
40 7283Q NEUROTOPREL 100MG TAB (ABB/PHA) TOPIRAMATE (C) 30'S C 2.4373 100MG 2022-04-01 2023-03-31 No No Delete from contract 0
41 7283S APO-TOPIRAMATE 100MG TAB (APO) (BP) 100'S BP 0.1699 100MG 120 2024-04-01 2026-03-31 6
41 7283T TOPIRAMATE 100MG TAB (ZYD) 60'S BP 0.1582 100MG 120 2025-01-27 2026-03-31 6
40 72841 TOPAMAX 50MG TAB (JAC/STO) TOPIRAMATE 20'S C 1.97 50MG 0 2022-04-01 2024-03-31 0
41 72841 TOPAMAX 50MG TAB (JAC) TOPIRAMATE (C) 20'S C 1.9721 50MG 90 2024-04-01 2026-03-31 6
40 72849 TOPIRAMATE 50MG TAB (CIP/AHI) 60'S BP 0.12 50MG 0 2022-04-01 2022-09-30 0
40 7284D TOPAZ 50MG TAB (INP/AAL) TOPIRAMATE 60'S BP 0.16 50MG 0 2022-04-01 2024-03-31 6
40 7284E NEUROTOPREL 50MG TAB (ABB/PHA) TOPIRAMATE 30'S C 1.68 50MG 0 2022-04-01 2024-03-31 0
40 7284E NEUROTOPREL 50MG TAB (ABB/PHA) TOPIRAMATE (C) 30'S C 1.6753 50MG 2022-04-01 2023-03-31 No No Delete from contract 0