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Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
42 3501AT VITAMIN C 250MG TAB (LDP) VITAMIN C VITAMIN 100'S B 8.32 0.08 TAB 30 BLIS LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 8812 VITAMIN C 2026-04-01 2028-03-31 ORAL 6 VITAMIN C
42 3501AU VITAMIN C 500MG TAB (LDP) VITAMIN C VITAMIN 100'S B 8.97 0.09 TAB 30 BLIS LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 8812 VITAMIN C 2026-04-01 2028-03-31 ORAL 6 VITAMIN C
41 3501AW QC VITAMIN C 500MG TAB (INF) ASCORBIC ACID ASCORBIC ACID QC VITAMIN C 250'S B 22.99 0.092 TAB BLIS INF INFOCUS REMEDIES PVT RXP RX PRO INC 8812 VITAMIN C 2024-11-11 2025-02-28 ORAL VITAMIN C 2024-11-11
42 3501AY VITA C EZE 500MG TAB (INF) VITAMIN C VITAMIN C VITA C EZE 10X10 B 10.19 0.10 TAB 30 BLIS INF INFOCUS REMEDIES PVT RXP RX PRO INC 8812 VITAMIN C 2026-04-01 2028-03-31 ORAL 6 VITAMIN C
40 3501Z VITAMIN C 500MG TAB (KWA/ATB) VITAMIN C VITAMIN C 100'S B 7.20 0.07 TABLET 30 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8812 VITAMIN C 2022-04-07 2022-09-30 Oral 6 VITAMINS 2022-04-07
41 3501Z VITAMIN C 500MG TAB (KWA) (B) VITAMIN C VITAMIN C 100'S B 8.02 0.0802 TAB 30 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8812 VITAMIN C 2024-04-01 2026-03-31 ORAL 6 VITAMIN C
40 35027 VITAMIN C 250MG/ML INJ (LDP/AHI) VITAMIN C VITAMIN C 10X2ML BQ 48.93 4.89 INJECTION 0 AMP LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 8812 VITAMIN C 2022-04-01 2024-03-31 IV 0 VITAMINS
40 35215 PHYTOMENADIONE 10MG TAB (SLS/AHI) PHYTOMENADIONE PHYTOMENADIONE 20'S A 29.96 1.50 TABLET 90 TAB SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8824 VITAMIN K ACTIVITY 2022-04-01 2024-03-31 Oral 6 VITAMINS
41 35215 KENADIONE 10MG TAB (SLS) PHYTOMENADIONE (C) PHYTOMENADIONE KENADIONE 2X10 C 29.96 1.4978 TAB 90 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8824 VITAMIN K ACTIVITY 2024-04-01 2026-03-31 ORAL 6 VITAMIN K ACTIVITY
42 35215 KENADIONE 10MG TAB (SLS) PHYTOMENADIONE PHYTOMENADIONE KENADIONE 2X10 A 29.96 1.50 TAB 90 BLIS SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8824 VITAMIN K ACTIVITY 2026-04-01 2028-03-31 ORAL 6 VITAMIN K ACTIVITY
41 35216 PHYTOMENADIONE 10MG TAB (KWA) PHYTOMENADIONE PHYTOMENADIONE 10'S A 8.29 0.8291 TAB 90 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8824 VITAMIN K ACTIVITY 2024-04-01 2026-03-31 ORAL 6 VITAMIN K ACTIVITY
40 3522J LADION 1MG IV/IM INJ (LDP/AHI) PHYTOMENADIONE PHYTOMENADIONE LADION 10X0.5ML B 57.08 5.71 INJECTION 0 AMP LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 8824 VITAMIN K ACTIVITY 2022-04-01 2024-03-31 IV/IM 0 VITAMINS
41 3522J LADION 1MG IV/IM INJ (LDP) PHYTOMENADION (B) PHYTOMENADIONE LADION 10X0.5ML B 57.08 5.7085 AMP 0 BOX LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 8824 VITAMIN K ACTIVITY 2024-04-01 2026-03-31 IV/IM 0 VITAMIN K ACTIVITY
42 3522M PHYTOMENADIONE 1MG IM INJ (SLS) PHYTOMENADIONE PHYTOMENADIONE 25X0.5ML B 214.75 8.59 AMPG 2 SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8824 VITAMIN K ACTIVITY 2026-04-02 2028-03-31 IM 0 VITAMIN K ACTIVITY 2026-04-02
40 3523F PHYTOMENADIONE 10MG/ML IV/IM INJ (RTM/PHA) PHYTOMENADIONE PHYTOMENADIONE 10X1ML B 40.23 4.02 INJECTION 0 AMP RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 8824 VITAMIN K ACTIVITY 2022-04-01 IV/IM 0 VITAMINS
40 3523F PHYTOMENADIONE 10MG/ML IV/IM INJ (RTM/PHA) PHYTOMENADIONE PHYTOMENADIONE 10X1ML B 15.40 1.54 INJECTION 0 AMP RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 8824 VITAMIN K ACTIVITY 2022-07-19 2024-03-31 Price Change IV/IM 0 VITAMINS 2022-07-18
41 3523F PHYTOMENADIONE 10MG/ML IV/IM INJ (RTM) (B) PHYTOMENADIONE PHYTOMENADIONE 10X1ML B 41.07 4.1074 AMP 2 BOX RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 8824 VITAMIN K ACTIVITY 2024-04-01 2026-03-31 IV/IM 0 VITAMIN K ACTIVITY
40 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS PRENATAL MULTIVITAMINS PRENATAL NATELE 28'S C 13.97 0.50 CAPSULE 0 CAP BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2022-09-30 Oral 0 VITAMINS 2022-03-29
40 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS + M (C) MULTIVITAMINS PRENATAL NATELE 28'S C 14.9 0.5321 CAPSULE BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 8828 MULTIVITAMIN PREPARATIONS 2022-10-01 2023-02-20 Price Change Oral 0 MULTIVITAMIN PREPARATIONS 2023-02-02
40 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS PRE (C) MULTIVITAMINS PRENATAL NATELE 28'S C 15.33 0.5475 CAPSULE BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 8828 MULTIVITAMIN PREPARATIONS 2023-02-21 2024-03-31 Add to Contract as Cat C Oral MULTIVITAMIN PREPARATIONS 2023-02-21