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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 A061C FLUDARABINE 50MG INJ (INP/AHI) FLUDARABINE FLUDARABINE 50MG VIAL BQ 134.61 134.61 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
42 A061F FLUDARABINE 50MG INJ (KWA) FLUDARABINE FLUDARABINE 50MG VIAL BQ 626.93 626.93 VIAL 0 KWA KWALITY PHARMACEUTICALS STO BRYDEN STOKES LTD 1000 ANTINEOPLASTICS 2026-04-01 Add to Contract IV 0 ANTINEOPLASTICS 2026-03-02