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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 19633 CALCIUM GLUCONATE 10% INJ (BRA/COL) CALCIUM GLUCONATE CALCIUM GLUCONATE 20X10ML B 31.26 1.56 INJECTION 0 AMP BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4012 REPLACEMENT THERAPY 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 19633 CALCIUM GLUCONATE 10% INJ (BRA) (B) CALCIUM GLUCONATE CALCIUM GLUCONATE 20X10ML B 13.43 0.6714 AMP 10 BOX BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
42 19633 CALCIUM GLUCONATE 10% INJ (BRA) CALCIUM GLUCONATE CALCIUM GLUCONATE 20X10ML B 32.62 1.63 AMPG 10 BOX BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 4012 REPLACEMENT THERAPY 2026-04-01 IV 0 REPLACEMENT THERAPY
42 1963V INJECAL 10% INJ (FSB) CALCIUM GLUCONATE CALCIUM GLUCONATE INJECAL 20X10ML B 12.78 0.64 AMPG 10 AMP FSB FLAGSHIP BIOTECH AHI ARMSTRONG HEALTHCARE INC 4012 REPLACEMENT THERAPY 2026-04-01 Package Size Change INJECTION 0 REPLACEMENT THERAPY 2026-01-22
42 1963W INJECAL 10% INJ (FSB) CALCIUM GLUCONATE CALCIUM GLUCONATE INJECAL 2X5X10ML B 6.39 6.39 AMPG 10 AMP FSB FLAGSHIP BIOTECH AHI ARMSTRONG HEALTHCARE INC 4012 REPLACEMENT THERAPY 2026-04-01 Add to Contract as Cat B INJECTION 0 REPLACEMENT THERAPY 2026-01-22