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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
41 3501AW QC VITAMIN C 500MG TAB (INF) ASCORBIC ACID ASCORBIC ACID QC VITAMIN C 250'S B 22.99 0.092 TAB BLIS INF INFOCUS REMEDIES PVT RXP RX PRO INC 8812 VITAMIN C 2024-11-11 2025-02-28 ORAL VITAMIN C 2024-11-11