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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 10518 AMINOCAPROIC ACID 250MG/ML INJ (SLS/AHI) AMINOCAPROIC ACID AMINOCAPROIC ACID 20ML BQ 20.09 20.09 INJECTION 0 VIAL SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 10518 AMINOCAPROIC ACID 250MG/ML INJ (SLS (BQ) AMINOCAPROIC ACID AMINOCAPROIC ACID 20ML BQ 20.2 20.1971 VIAL 10 VIAL SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2024-04-01 2026-03-31 IV 0 HEMOSTATICS