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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
41 6732U ULTRAVIST 300 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 100ML BQ 74.97 74.9714 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6732U ULTRAVIST 300 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 68.23 68.23 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 2028-03-31 IV 0 ROENTGENOGRAPHY
40 6732V ULTRAVIST 300 INJ (BSP/AHI) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 68.61 68.61 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6732V ULTRAVIST 300 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 100ML BQ 74.97 74.9714 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6732V ULTRAVIST 300 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 74.97 74.97 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2026-04-01 2028-03-31 IV 0 ROENTGENOGRAPHY
40 6732Z CONTRAPAQUE 300MG/ML INJ (UNI/AHI) IOHEXOL IOHEXOL CONTRAPAQUE 50ML BQ 42.70 42.70 INJECTION 0 VIAL UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
40 6734AC GADOVIST 604MG/ML INJ (BSP/AHI) GADOBUTROL GADOBUTROL GADOVIST 7.5ML BQ 135.43 135.43 INJECTION 0 VIAL BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6734AC GADOVIST 604MG/ML INJ (BSP) GADOBUT (C) GADOBUTROL GADOVIST 7.5ML C 135.73 135.7259 VIAL 0 VIAL BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6734AC GADOVIST 604MG/ML INJ (BSP) GADOBUT GADOBUTROL GADOVIST 7.5ML C 135.73 135.73 VIAL 0 VIAL BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2026-04-01 2028-03-31 IV 0 ROENTGENOGRAPHY
40 6734AQ CONTRAPAQUE 350MG/ML INJ (UNI/AHI) IOHEXOL IOHEXOL CONTRAPAQUE 50ML BQ 43.06 43.06 INJECTION 0 VIAL UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
40 6734Q ULTRAVIST 370 INJ (BSP/COL) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 46.76 46.76 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6734Q ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 50ML BQ 51.08 51.0773 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6734Q ULTRAVIST 370 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 51.27 51.27 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 2028-03-31 IV 0 ROENTGENOGRAPHY
40 6734R ULTRAVIST 370 INJ (BSP/AHI) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 46.76 46.76 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6734R ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 50ML BQ 51.08 51.0773 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6734R ULTRAVIST 370 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 56.32 56.32 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2026-04-01 2028-03-31 IV 0 ROENTGENOGRAPHY
40 6734Z GADOVIST 604MG/ML INJ (BSP/COL) GADOBUTROL GADOBUTROL GADOVIST 7.5ML BQ 135.43 135.43 INJECTION 0 VIAL BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6734Z GADOVIST 604MG/ML INJ (BSP) GADOBUTROL (C) GADOBUTROL GADOVIST 7.5ML C 135.73 135.7259 VIAL 0 VIAL BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6734Z GADOVIST 604MG/ML INJ (BSP) GADOBUTROL GADOBUTROL GADOVIST 7.5ML C 123.52 123.52 VIAL 0 VIAL BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 2028-03-31 IV 0 ROENTGENOGRAPHY
40 67351 ULTRAVIST 370 INJ (BSP/AHI) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 103.05 103.05 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS