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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 4941AG ALBURX 25% INJ (CSL) HUMAN ALBUMIN HUMAN ALBUMIN ALBURX 50ML VIAL BQ 91.06 91.06 VIAL 0 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 Add to Contract IV 0 SERUMS 2025-11-10