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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 5921H DANAZOL 200MG TAB (CIP/AHI) DANAZOL DANAZOL 100'S C 645.85 6.46 TABLET 0 TAB CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 6808 ANDROGENS 2022-04-01 2022-09-30 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES 2022-03-29
42 5921L DANOGEN 200MG CAP (CIP) DANAZOL DANAZOL DANOGEN 10X10 C 223.75 2.24 CAP 30 BLIS CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 6808 ANDROGENS 2026-04-01 ORAL 6 ANDROGENS