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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 22832 ACETAZOLAMIDE SR 250MG TAB (CHC/ATB) ACETAZOLAMIDE SR ACETAZOLAMIDE SR 100'S A 154.75 1.55 TABLET 60 TAB CHC CARITAS HEALTHCARE PVT LTD ATB ANSA TRADING BARBADOS LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE