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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 6801F ZEVERT 8MG TAB (INP/AHI) BETAHISTINE BETAHISTINE ZEVERT 120'S A 8.32 0.07 TABLET 90 TAB INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 2412 VASODILATING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 6801G BETASERC 16MG TAB (ABB/PHA) BETAHISTINE BETAHISTINE BETASERC 20'S C 12.56 0.63 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 2412 VASODILATING AGENTS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
40 6801G BETASERC 16MG TAB (ABB/PHA) BETAHISTINE (C) BETAHISTINE BETASERC 20'S C 12.56 0.628 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 2412 VASODILATING AGENTS 2022-04-01 2023-03-31 Delete from contract Oral 0 VASODILATING AGENTS 2023-03-02
41 6801H ZEVERT 16MG TAB (INP) BETAHISTINE BETAHISTINE ZEVERT 5X10 A 7.88 0.1577 TAB 90 BOX INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 2412 VASODILATING AGENTS 2024-04-01 2026-03-31 ORAL 6 VASODILATING AGENTS
42 6801M VERTILINE 16MG TAB (JLP) BETAHISTINE BETAHISTINE VERTILINE 10X10 A 6.80 0.07 TAB 90 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 2412 VASODILATING AGENTS 2026-04-01 ORAL 6 VASODILATING AGENTS