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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 0813B EPHEDRINE HCL 50MG/ML INJ (AKI) EPHEDRINE HCL EPHEDRINE HCL 10X1ML B 2248.76 224.8761 VIAL 30 BOX AKI AKORN INC. AHI ARMSTRONG HEALTHCARE INC 121212 ALPHA & BETA ADRENERGIC AGONIST 2024-04-01 2026-03-31 IV 6 ALPHA & BETA ADRENERGIC AGONIST
40 22014 TUSCOSED LINCTUS SYR (CAR/COL) DIPHEN/COD.PH CODEINE PHOSPHATE|DIPHENHYDRAMINE|EPHEDRINE HCL TUSCOSED LINCTUS 2 LITRES B 75.00 0.04 SYRUP 0 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 4808 ANTITUSSIVES 2022-04-01 2024-03-31 Oral 0 RESPIRATORY TRACT AGENTS
41 22014 TUSCOSED 2MG/ML|2.8MG/ML|1MG/ LINCT (CAR) CODEINE PHOSPHATE| (B) CODEINE PHOSPHATE|DIPHENHYDRAMINE|EPHEDRINE HCL TUSCOSED 2 LITRES B 81.17 0.0406 ML 150 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 4808 ANTITUSSIVES 2024-04-01 2026-03-31 ORAL 0 ANTITUSSIVES