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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 6734AC GADOVIST 604MG/ML INJ (BSP/AHI) GADOBUTROL GADOBUTROL GADOVIST 7.5ML BQ 135.43 135.43 INJECTION 0 VIAL BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6734AC GADOVIST 604MG/ML INJ (BSP) GADOBUT (C) GADOBUTROL GADOVIST 7.5ML C 135.73 135.7259 VIAL 0 VIAL BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6734AC GADOVIST 604MG/ML INJ (BSP) GADOBUT GADOBUTROL GADOVIST 7.5ML C 135.73 135.73 VIAL 0 VIAL BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2026-04-01 IV 0 ROENTGENOGRAPHY
40 6734Z GADOVIST 604MG/ML INJ (BSP/COL) GADOBUTROL GADOBUTROL GADOVIST 7.5ML BQ 135.43 135.43 INJECTION 0 VIAL BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6734Z GADOVIST 604MG/ML INJ (BSP) GADOBUTROL (C) GADOBUTROL GADOVIST 7.5ML C 135.73 135.7259 VIAL 0 VIAL BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6734Z GADOVIST 604MG/ML INJ (BSP) GADOBUTROL GADOBUTROL GADOVIST 7.5ML C 123.52 123.52 VIAL 0 VIAL BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 IV 0 ROENTGENOGRAPHY