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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
40 A413L CARDOZ 6.25MG TAB (IPC/ATB) CARVEDILOL CARVEDILOL CARDOZ 28'S A 2.20 0.08 TABLET 60 TAB IPC IPCA Laboratories Ltd. ATB ANSA TRADING BARBADOS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 A471J CLEXANE 20MG INJ (SFA/COL) ENOXAPARIN ENOXAPARIN CLEXANE 2X20MG B 15.77 7.89 INJECTION 0 PFS SFA SANOFI AVENTIS COL COLLINS LTD 20120416 HEPARINS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 A471J CLEXANE 20MG INJ (SFA) ENOXAPARIN (B) ENOXAPARIN CLEXANE 2X20MG B 19.03 9.5142 PFS 30 BOX SFA SANOFI AVENTIS COL COLLINS LTD 20120416 HEPARINS 2024-04-01 2026-03-31 IV 6 HEPARINS
41 A471R ENOXAPARIN 20MG INJ (GLN) (B) ENOXAPARIN ENOXAPARIN 2X20MG B 11.82 5.9124 PFS 30 BOX GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2024-04-01 2026-03-31 IV 6 HEPARINS
40 A471S DALTEPARIN 2500IU INJ (GLN/AHI) DALTEPARIN DALTEPARIN 2500IU B 5.08 5.08 INJECTION 0 PFS GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2022-04-01 2022-09-30 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-03-29
40 A472AD DALTEPARIN 5000IU INJ (GLN/AHI) DALTEPARIN DALTEPARIN 5000IU B 7.88 7.88 INJECTION 0 PFS GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2022-04-01 2022-06-29 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-03-29
40 A472AD DALTEPARIN 5000IU INJ (GLN/AHI) DALTEPARIN DALTEPARIN 5000IU B 24.06 24.06 INJECTION 0 PFS GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2022-06-30 2024-03-31 Price Change IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-06-30
41 A472AD DALTEPARIN 5000IU INJ (GLN) (B) DALTEPARIN DALTEPARIN 5000IU B 24.06 24.0572 PFS 10 BOX GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2024-04-01 2026-03-31 IV 6 HEPARINS
41 A472BM DALTEPARIN 5000IU INJ (LDP) (B) DALTEPARIN DALTEPARIN 0.4ML PFS B 22.62 22.6165 PFS 10 PFS LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2024-04-01 2026-03-31 SC 6 HEPARINS
40 A472G CLEXANE 40MG INJ (SFA/COL) ENOXAPARIN ENOXAPARIN CLEXANE 2X40MG B 19.03 9.52 INJECTION 0 PFS SFA SANOFI AVENTIS COL COLLINS LTD 20120416 HEPARINS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 A472G CLEXANE 40MG INJ (SFA) ENOXAPARIN (C) ENOXAPARIN CLEXANE 2X40MG C 19.71 9.8539 PFS 30 BOX SFA SANOFI AVENTIS COL COLLINS LTD 20120416 HEPARINS 2024-04-01 2026-03-31 IV 6 HEPARINS
40 A472H CLEXANE 60MG INJ (SFA/COL) ENOXAPARIN ENOXAPARIN CLEXANE 2X60MG B 24.74 12.37 INJECTION 0 PFS SFA SANOFI AVENTIS COL COLLINS LTD 20120416 HEPARINS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 A472H CLEXANE 60MG INJ (SFA) ENOXAPARIN (B) ENOXAPARIN CLEXANE 2X60MG B 25.09 12.545 PFS 30 BOX SFA SANOFI AVENTIS COL COLLINS LTD 20120416 HEPARINS 2024-04-01 2026-03-31 IV 6 HEPARINS
40 A472X ENOXAPARIN 40MG INJ (GLN/AHI) ENOXAPARIN ENOXAPARIN 2X40MG B 15.09 7.55 INJECTION 30 PFS GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2022-04-01 2022-05-10 IV 6 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-03-29
40 A472X ENOXAPARIN 40MG INJ (GLN/AHI) ENOXAPARIN ENOXAPARIN 2X40MG B 18.70 9.35 INJECTION 30 PFS GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2022-06-13 2024-03-31 Price Change IV 6 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-06-13
41 A472X ENOXAPARIN 40MG INJ (GLN) (B) ENOXAPARIN ENOXAPARIN 2X40MG B 18.7 9.3511 PFS 30 BOX GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2024-04-01 2026-03-31 IV 6 HEPARINS
40 A472Y ENOXAPARIN 60MG INJ (GLN/AHI) ENOXAPARIN ENOXAPARIN 2X60MG B 24.33 12.17 INJECTION 30 PFS GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2022-06-13 2024-03-31 Price Change IV 6 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-06-13
41 A472Y ENOXAPARIN 60MG INJ (GLN) (B) ENOXAPARIN ENOXAPARIN 2X60MG B 24.33 12.1645 PFS 30 BOX GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2024-04-01 2026-03-31 IV 6 HEPARINS
40 A473D CLEXANE 80MG INJ (SFA/COL) ENOXAPARIN ENOXAPARIN CLEXANE 2X80MG B 30.99 15.50 INJECTION 0 PFS SFA SANOFI AVENTIS COL COLLINS LTD 20120416 HEPARINS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 A473D CLEXANE 80MG INJ (SFA) ENOXAPARIN (B) ENOXAPARIN CLEXANE 2X80MG B 32.08 16.0381 PFS 30 BOX SFA SANOFI AVENTIS COL COLLINS LTD 20120416 HEPARINS 2024-04-01 2026-03-31 IV 6 HEPARINS