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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 4222G ACETYLCYSTEINE 20% SOLN (DIL/AHI) ACETYLCYSTEINE ACETYLCYSTEINE 3X30ML BQ 273.82 91.27 SOLUTION 0 VIAL DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 9212 ANTIDOTES 2022-04-01 2024-03-31 IV 0 UNCLASSIFIED THERAPEUTIC AGENTS
40 4222H MUCOSYS 20% INJ (UBI/RXP) ACETYLCYSTEINE ACETYLCYSTEINE MUCOSYS 10ML BQ 8.83 8.83 INJECTION 0 VIAL UBI UNITED BIOTECH (P) LIMITED RXP RX PRO INC 9212 ANTIDOTES 2022-04-01 2024-03-31 IV 0 UNCLASSIFIED THERAPEUTIC AGENTS
41 4222K ACETYLCYSTEINE 20% SOLN (KWA) ACETYLCYSTEINE ACETYLCYSTEINE 10ML VIAL BQ 23.5679 23.5679 VIAL 3 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 9212 ANTIDOTES 2024-04-01 2026-03-31 ORAL INHALATION 12 ANTIDOTES
42 4222N ACETYLCYSTEINE 200MG/ML INJ (MTP) ACETYLCYSTEINE ACETYLCYSTEINE 10X10ML BQ 67.82 6.78 VIAL 3 AMP MTP MARTINDALE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 9212 ANTIDOTES 2026-04-01 IV 0 ANTIDOTES