Displaying 1 - 13 of 13
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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 12116 ANGIRON 0.5MG SL TAB (CIR/AHI) GLYCERYL TRINI GLYCERYL TRINITRATE ANGIRON 30'S A 11.53 11.53 TABLET 30 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 12118 GLYCERYL TRINITRATE 0.6MG TAB (KWA) GLYCERYL TRINITRATE GLYCERYL TRINITRATE 100'S A 18.0225 0.1802 TAB 30 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 2412 VASODILATING AGENTS 2024-04-01 2026-03-31 ORAL 6 VASODILATING AGENTS
40 12121 MINITRAN 5MG PATCH (PMA/AHI) GLYCERYL TRINITR GLYCERYL TRINITRATE MINITRAN 30'S BQ 46.21 46.21 PATCH 0 PACK PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 TOPICAL 6 CARDIOVASCULAR DRUGS
41 12121 MINITRAN 5MG PATCH (PMA) GLYCERYL TRINIT (BQ) GLYCERYL TRINITRATE MINITRAN 30'S BQ 54.37 54.3665 PACK 6 BOX PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 TOPICAL 0 NITRATES AND NITRITES
40 1212F NITRODERM TTS 5 25MG PATCH (BCH/COL) GLYCERYL GLYCERYL TRINITRATE NITRODERM TTS 5 10'S BQ 19.68 19.68 PATCH 0 PACK BCH SANDOZ COL COLLINS LTD 241208 NITRATES AND NITRITES 2022-04-01 2022-05-24 Delete from contract TOPICAL 0 CARDIOVASCULAR DRUGS 2022-04-12
40 1212G NITRODERM TTS 10 50MG PATCH (BCH/COL) GLYCERY GLYCERYL TRINITRATE NITRODERM TTS 10 10'S BQ 45.40 45.40 PATCH 0 PACK BCH SANDOZ COL COLLINS LTD 241208 NITRATES AND NITRITES 2022-04-01 2022-05-24 Delete from contract TOPICAL 6 CARDIOVASCULAR DRUGS 2022-04-12
41 12136 NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL (BQ) GLYCERYL TRINITRATE NITROGLYCERINE 25X5ML BQ 171.25 6.8502 AMP 0 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 IV 0 NITRATES AND NITRITES
42 12136 NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL GLYCERYL TRINITRATE NITROGLYCERINE 25X5ML BQ 171.93 6.88 AMPG 0 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2026-04-01 IV 0 NITRATES AND NITRITES
40 12138 GLYCERYL TRINITRATE 5MG/ML INJ (MON/PHA) GLYCERYL TRINITRATE GLYCERYL TRINITRATE 5X5ML BQ 9.46 1.89 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 IV 0 CARDIOVASCULAR DRUGS
41 12138 GLYCERYL TRINITRATE 5MG/ML INJ (MON (BQ) GLYCERYL TRINITRATE GLYCERYL TRINITRATE 5X5ML BQ 8.89 1.7778 AMP 0 BOX MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 IV 0 NITRATES AND NITRITES
40 12148 NITROCARD 0.4MG SPRAY (ARP/AHI) GLYCERYL TRIN GLYCERYL TRINITRATE NITROCARD 200 DOSES A 17.61 17.61 SPRAY 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 12149 TROCER 0.4MG SPRAY (INC) GLYCERYL TRINITRATE GLYCERYL TRINITRATE TROCER 200 DOSES A 18.2671 18.2671 BOTT 1 BOTT INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL INHALATION 6 NITRATES AND NITRITES
42 12149 TROCER 0.4MG SPRAY (INC) GLYCERYL TRINITRATE GLYCERYL TRINITRATE TROCER 200 DOSES A 18.51 18.51 BOTT 1 BOTT INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2026-04-01 ORAL INHALATION 6 NITRATES AND NITRITES