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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 26719 FLUDROCORTISONE 0.1MG TAB (SLS/AHI) FLUDROCORTISONE FLUDROCORTISONE 200'S A 162.83 0.81 TABLET 60 TAB SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 2671A FLUDROCORTISONE 0.1MG TAB (SLS) FLUDROCORTISONE FLUDROCORTISONE 200'S A 167.45 0.8372 TAB 60 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2024-04-01 2026-03-31 ORAL 6 ADRENALS
42 2671A FLUDROCORTISONE 0.1MG TAB (SLS) FLUDROCORTISONE FLUDROCORTISONE 200'S A 167.97 0.84 TAB 60 BLIS SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2026-04-01 ORAL 6 ADRENALS