Contract Changes [0081AK, 2026-04-01]

Contract Number	42
Brand Code	0081AK
Drug	AMPHIZOME 50MG INJ (FSB) AMPHOTERICIN B
LAgent Code	STO
Package Size	5ML
Formulary Category	BQ
Package Price	12.53
Protocol Monthly Max	21
Drug Contract Start Date	2026-04-01
Drug Contract End Date
Contract Changed	Add to Contract
Change Date	2026-03-05