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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 72712 CHROMIUM 4 MCG/ML INJ (KWA/ATB) CHROMIUM CHROMIUM 10ML BQ 212.03 212.03 INJECTION 0 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 4012 REPLACEMENT THERAPY 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 72712 CHROMIUM 4 MCG/ML INJ (KWA) CHROMIUM CHROMIUM 10ML BQ 180.2249 180.2249 VIAL 30 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 6 REPLACEMENT THERAPY
42 72713 CHROMIUM 4MCG/ML INJ (KWA) CHROMIUM CHROMIUM 10ML BQ 459.75 459.75 VIAL 0 KWA KWALITY PHARMACEUTICALS STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2026-04-01 Add to Contract IV 0 REPLACEMENT THERAPY 2026-03-02