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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
42 B8012 FIRIALTA 10MG TAB (BSP) FINERENONE (C) FINERENONE FIRIALTA 28'S C 132.43 4.73 TAB BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 243220 ALDOSTERONE RECEPTOR ANTAGONIST 2026-04-01 Add to Contract as Cat C ORAL ALDOSTERONE RECEPTOR ANTAGONIST 2026-04-07
42 B8021 FIRIALTA 20MG TAB (BSP) FINERENONE (C) FINERENONE FIRIALTA 28'S C 132.43 4.73 TAB BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 243220 ALDOSTERONE RECEPTOR ANTAGONIST 2026-04-01 Add to Contract as Cat C ORAL ALDOSTERONE RECEPTOR ANTAGONIST 2026-04-07