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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 0131AL ERYTHROMYCIN 50MG/ML SUSP (BON/COL) ERYTHROMY ERYTHROMYCIN ESTOLATE ERYTHROMYCIN 60ML A 7.75 0.13 SUSPENSION 300 ML BON CORPORACION BONIMA COL COLLINS LTD 08121204 ERYTHROMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0141GC AAP-ERYTHROMYCIN 250MG TAB (APO/COL) ERYTHROMYCIN BASE ERYTHROMYCIN BASE AAP-ERYTHROMYCIN 100'S A 33.60 0.34 TABLET 56 TAB APO APOTEX INC. COL COLLINS LTD 08121204 ERYTHROMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0141GH ERYTHROMYCIN 250MG TAB (MBL) ERYTHROMYCIN BASE ERYTHROMYCIN 100'S A 32.54 0.3254 TAB 56 BOX MBL MEDICAMEN BIOTECH LTD AHI ARMSTRONG HEALTHCARE INC 08121292 OTHER MACROLIDES 2024-04-01 2026-03-31 ORAL 0 OTHER MACROLIDES
40 0142B ERYTHROMYCIN 5% EYE OINT (AKI/AHI) ERYTHROMYCIN ERYTHROMYCIN 3.5G C 67.31 67.31 EYE OINTMENT 0 TUBE AKI AKORN INC. AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 4021E ERYTHROMYCIN 500MG INJ (CIR/AHI) ERYTHROMYCIN LACTOBIONATE ERYTHROMYCIN 500MG VIAL BQ 28.92 28.92 INJECTION 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 08121204 ERYTHROMYCINS 2022-04-01 2024-03-31 IV 6 ANTI-INFECTIVE AGENTS
41 4021E ERYTHROMYCIN 500MG INJ (CIR) (BQ) ERYTHROMYCIN LACTOBIONATE ERYTHROMYCIN 500MG VIAL BQ 28.92 28.923 VIAL 56 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 08121204 ERYTHROMYCINS 2024-04-01 2026-03-31 IV 1 ERYTHROMYCINS
42 4021E ERYTHROMYCIN 500MG INJ (CIR) ERYTHROMYCIN LACTOBIONATE ERYTHROMYCIN 500MG VIAL BQ 29.79 29.79 VIAL 56 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 08121204 ERYTHROMYCINS 2026-04-01 IV 0 ERYTHROMYCINS
41 4021P ERYTHROMYCIN 500MG INJ (KWA) ERYTHR (BQ) ERYTHROMYCIN LACTOBIONATE ERYTHROMYCIN 500MG VIAL BQ 26.34 26.3406 VIAL 56 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 08121204 ERYTHROMYCINS 2024-04-01 2026-03-31 IV 1 ERYTHROMYCINS