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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 21617 HYALASE 1500IU INJ (CPP/COL) HYALURONIDASE HYALURONIDASE HYALASE 1500IU BQ 42.95 42.95 INJECTION 0 AMP CPP WOCKHARDT UK LTD COL COLLINS LTD 4400 ENZYMES 2022-04-01 2024-03-31 IV 0 ENZYMES
40 2161D HYALURONIDASE 1500IU INJ (SLS/AHI) HYALURONIDASE HYALURONIDASE 10X10ML BQ 111.94 11.19 INJECTION 0 AMP SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 4400 ENZYMES 2022-04-01 2024-03-31 IV 0 ENZYMES
41 2161D HYALURONIDASE 1500IU INJ (SLS (BQ) HYALURONIDASE HYALURONIDASE 10X10ML BQ 112.05 11.2049 AMP 0 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 4400 ENZYMES 2024-04-01 2026-03-31 IV 0 ENZYMES
41 2161E HYALURONIDASE 1500IU INJ (KWA) (BQ) HYALURONIDASE HYALURONIDASE 20MG AMP BQ 10.79 10.7917 AMP 0 AMP KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 4400 ENZYMES 2024-04-01 2026-03-31 IV 0 ENZYMES
42 2161H HYALASE 1500U INJ (CPP) HYALURONIDASE HYALURONIDASE HYALASE 10X1ML C 623.04 62.30 AMPG 0 AMP CPP WOCKHARDT UK LTD COL AVENTA BARBADOS 4400 ENZYMES 2026-04-01 SC 0 ENZYMES
42 2161J ENTODASE 1500U INJ (SLS) HYALURONIDASE HYALURONIDASE ENTODASE 10X1ML BQ 83.67 8.37 AMPG 0 AMP SLS SAMARTH LIFE SCIENCES PSB PHARMACEUTICAL SOLUTIONS BARBA 4400 ENZYMES 2026-04-01 OPHTHALMIC 0 ENZYMES