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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 0813C EPHEDRINE HCL 50MG/ML INJ (VEV/AHI) EPHEDRINE HYDROCHLORIDE EPHEDRINE HCL 10X1ML B 268.43 26.84 INJECTION 0 VIAL VEV VERVE HUMANCARE LABORATORIES AHI ARMSTRONG HEALTHCARE INC 121212 ALPHA & BETA ADRENERGIC AGONIST 2022-04-01 2022-09-30 IV 0 AUTONOMIC DRUGS 2022-03-29