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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 A1916 ALPROSTADIL 500MCG/ML INJ (SLS/AHI) ALPROSTADIL ALPROSTADIL 1ML AMP BQ 399.59 399.59 INJECTION 0 AMP SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 241292 VASODILATING AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 IV 0 CARDIOVASCULAR DRUGS
42 A1916 ALPROSTADIL 500MCG/ML INJ (SLS) ALPROSTADIL ALPROSTADIL 1ML AMP BQ 398.07 398.07 AMPG 7 AMP SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 241292 VASODILATING AGENTS, MISCELLANEOUS 2026-04-01 IV 0 VASODILATING AGENTS, MISCELLANEOUS
40 A1917 BIOGLANDIN 500MCG/ML INJ (UBI/RXP) ALPROSTADI ALPROSTADIL BIOGLANDIN 1ML AMP BQ 237.85 237.85 INJECTION 0 AMP UBI UNITED BIOTECH (P) LIMITED RXP RX PRO INC 241292 VASODILATING AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 IV 0 CARDIOVASCULAR DRUGS
41 A1919 ALPROSTADIL 500MCG/ML INJ (KWA) ALPROSTADIL ALPROSTADIL 1ML AMP BQ 485.2208 485.2208 AMP 7 AMP KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 241292 VASODILATING AGENTS, MISCELLANEOUS 2024-04-01 2026-03-31 IV 6 VASODILATING AGENTS, MISCELLANEOUS