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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 49412 PLASBUMIN 25% INJ (GRB/COL) ALBUMIN ALBUMIN PLASBUMIN 12.5G VIAL BQ 101.94 101.94 INJECTION 0 VIAL GRB GRIFOLS BIOLOGICALS INC COL COLLINS LTD 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 49416 ALBUREX 20% INJ (CSL) ALBUMIN (BQ) ALBUMIN ALBUREX 50ML VIAL BQ 73.12 73.1229 VIAL 40 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IM 0 SERUMS
42 49418 ALBUREL 25% INJ (RLS) ALBUMIN ALBUMIN ALBUREL 50ML BQ 127.87 127.87 VIAL 40 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 IV 0 SERUMS
42 4941A ALBUMIN 20% INJ (INP) ALBUMIN ALBUMIN 50ML VIAL BQ 277.27 277.27 VIAL 40 VIAL INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 8004 SERUMS 2026-04-01 IV 0 SERUMS
42 4941AG ALBURX 25% INJ (CSL) HUMAN ALBUMIN HUMAN ALBUMIN ALBURX 50ML VIAL BQ 91.06 91.06 VIAL 0 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 Add to Contract IV 0 SERUMS 2025-11-10
42 4941C ALBUMIN 20% INJ (INP) ALBUMIN ALBUMIN 50ML BQ 277.27 277.27 VIAL 40 AMPG INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 IV 0 SERUMS
41 4941U ALBUREX 25% INJ (CSL) ALBUMIN (BQ) ALBUMIN ALBUREX 50ML VIAL BQ 91.06 91.0639 VIAL 40 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS