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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 3921CM DIPYRIDAMOLE 50MG TAB (LDP/AHI) DIPYRIDAMOLE DIPYRIDAMOLE 100'S BQ 49.72 0.50 TABLET 120 TAB LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 201218 PLATELET AGGREGATION INHIBITORS 2022-04-01 2024-03-31 Add to Contract as Cat B Oral 6 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-03-10
40 3921CQ DIPYRIDAMOLE 25MG TAB (LDP/AHI) DIPYRIDAMOLE DIPYRIDAMOLE 100'S BQ 49.72 0.50 TABLET 120 TAB LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 201218 PLATELET AGGREGATION INHIBITORS 2022-04-01 2024-03-31 Add to Contract as Cat B Oral 6 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-03-10
40 3921CS DIPYRIDAMOLE 75MG TAB (LDP/AHI) DIPYRIDAMOLE DIPYRIDAMOLE 100'S BQ 49.72 0.50 TABLET 120 TAB LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 201218 PLATELET AGGREGATION INHIBITORS 2022-04-01 2024-03-31 Add to Contract as Cat B Oral 6 BLOOD FORMATION, COAGULATION AND THROMBOSIS 2022-03-10
41 53013 ASPIRIN|DIPYRIDAMOLE 25MG|200MG ER (C) ASPIRIN|DIPYRIDAMOLE ASPIRIN|DIPYRIDAMOLE 60'S C 103.2963 1.7216 CAPER 0 BOX GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 2412 VASODILATING AGENTS 2024-04-01 2026-03-31 ORAL 0 VASODILATING AGENTS