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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
41 08011 DOPAMINE 40MG/ML INJ (RTM) (B) DOPAMINE DOPAMINE 10X5ML B 114.5 11.4496 AMP 0 BOX RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 121208 BETA ADRENERGIC AGONIST 2024-04-01 2026-03-31 IV 0 BETA ADRENERGIC AGONIST
40 0801P DOPAMINE 40MG/ML INJ (SLS/AHI) DOPAMINE DOPAMINE 25X5ML B 35.47 1.42 INJECTION 0 VIAL SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 121208 BETA ADRENERGIC AGONIST 2022-04-01 2024-03-31 IV 0 AUTONOMIC DRUGS
41 0801P DOPAMINE 40MG/ML INJ (SLS) (B) DOPAMINE DOPAMINE 25X5ML B 40.37 1.6147 VIAL 0 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 121208 BETA ADRENERGIC AGONIST 2024-04-01 2026-03-31 IV 0 BETA ADRENERGIC AGONIST
40 0801U DOPAMINE 40MG/ML INJ (MON/PHA) DOPAMINE DOPAMINE 5X5ML B 8.02 1.60 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 121208 BETA ADRENERGIC AGONIST 2022-04-01 2024-03-31 IV 0 AUTONOMIC DRUGS
41 0801V DOPAMINE 40MG/ML INJ (STP) (B) DOPAMINE DOPAMINE 10X5ML B 73.39 7.3395 AMP 0 BOX STP STEROP LABORATORIES COL COLLINS LTD 121208 BETA ADRENERGIC AGONIST 2024-04-01 2026-03-31 IV 0 BETA ADRENERGIC AGONIST