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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 20313 K BIND 15G PWDR (SLS) CALCIUM POLYSTYRENE SULPHONATE CALCIUM POLYSTYRENE SULPHONATE K BIND 20'S BQ 181.39 9.07 SACH 20 SACH SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 401818 POTASSIUM-REMOVING AGENTS 2026-04-01 ORAL 0 POTASSIUM-REMOVING AGENTS
40 20317 CALCIUM POLYSTYRENE SULPHONATE PWDR (SLS/AHI CALCIUM POLYSTYRENE SULPHONATE CALCIUM POLYSTYRENE SULPHONATE 300G A 159.76 159.76 POWDER 1 CAN SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 401818 POTASSIUM-REMOVING AGENTS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE