Displaying 1 - 8 of 8
  • Print
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 07211 CALCORT 6MG TAB (SFA/COL) DEFLAZACORT DEFLAZACORT CALCORT 10'S C 27.18 2.72 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 6804 ADRENALS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 07219 FLACORT 6MG TAB (ARP/AHI) DEFLAZACORT DEFLAZACORT FLACORT 3X10 C 8.97 0.30 TABLET 0 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 0721B DEFLARIN 6MG TAB (EXE) DEFLAZACORT (C) DEFLAZACORT DEFLARIN 10'S C 2.94 0.2936 TAB 0 BOX EXE EXELTIS ILAC COL COLLINS LTD 6804 ADRENALS 2024-04-01 2026-03-31 ORAL 0 ADRENALS
42 0721E DEFJOHN 6MG TAB (JLP) DEFLAZACORT DEFLAZACORT DEFJOHN 10X10 C 21.47 0.21 TAB 0 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2026-04-01 ORAL 0 ADRENALS
40 07221 CALCORT 30MG TAB (SFA/COL) DEFLAZACORT DEFLAZACORT CALCORT 10'S C 38.06 3.81 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 6804 ADRENALS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 07229 AVEXA 30MG TAB (MBL/AHI) DEFLAZACORT DEFLAZACORT AVEXA 1X10 C 29.00 2.90 TABLET 0 TAB MBL MEDICAMEN BIOTECH LTD AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 Add to Contract as Cat C oral 0 HORMONES AND SYNTHETIC SUBSTITUTES 2022-03-10
41 0722B DEFLAZACORT 30MG TAB (KWA) (C) DEFLAZACORT DEFLAZACORT 10'S C 13.86 1.3864 TAB 0 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 6804 ADRENALS 2024-04-01 2026-03-31 ORAL 0 ADRENALS
42 0722C DEFJOHN 30MG TAB (JLP) DEFLAZACORT DEFLAZACORT DEFJOHN 10X10 C 11.15 0.11 TAB 0 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2026-04-01 ORAL 0 ADRENALS