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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 53013 ASPIRIN|DIPYRIDAMOLE 25MG|200MG ER (C) ASPIRIN|DIPYRIDAMOLE ASPIRIN|DIPYRIDAMOLE 60'S C 103.2963 1.7216 CAPER 0 BOX GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 2412 VASODILATING AGENTS 2024-04-01 2026-03-31 ORAL 0 VASODILATING AGENTS