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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
42 64916 CALCIUM CHLORIDE 10% INJ (MTP) CALCIUM CHLORIDE CALCIUM CHLORIDE 10ML AMP B 40.99 40.99 AMPG 0 AMP MTP MARTINDALE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 4012 REPLACEMENT THERAPY 2026-04-01 IV 0 REPLACEMENT THERAPY