Displaying 1 - 11 of 11
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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 2691AA HYDROCORTISONE SOD SUCC 100MG INJ (CIR/AHI) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 100MG VIAL B 1.98 1.98 INJECTION 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 2691AA HYDROCORTISONE SOD SUCC 100MG INJ (CIR) (B) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 100MG VIAL B 2.31 2.3106 VIAL 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2024-04-01 2026-03-31 IV 0 ADRENALS
41 2691AC HYDROCORTISONE SOD SUCC 100MG INJ ( (B) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 100MG VIAL B 2.09 2.0931 VIAL 0 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 6804 ADRENALS 2024-04-01 2026-03-31 IV 0 ADRENALS
40 2691AF HYDROCORTISONE SOD SUCC 100MG INJ (MON/PHA) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 100MG VIAL B 2.99 2.99 INJECTION 0 VIAL MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 6804 ADRENALS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
42 2691AT LEECORT 100MG INJ (JLP) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SODIUM SUCCINATE LEECORT 25X5ML B 21.75 0.87 VIAL 0 VIAL JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2026-04-01 IV/IM 0 ADRENALS
42 2691AU HYDROCORTISONE SOD SUCC 100MG INJ (FSB) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 100MG VIAL B 0.71 0.71 VIAL 0 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 6804 ADRENALS 2026-04-01 Add to Contract as Cat B IV 0 ADRENALS 2026-03-05
41 2692D HYDROCORTISONE SOD SUCC 250MG INJ (MON) HYDROCORTISONE SODIU (B) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 250MG VIAL B 3.43 3.4251 VIAL 0 VIAL MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 6804 ADRENALS 2024-04-01 2026-03-31 IV 0 ADRENALS
42 2692D HYDROCORTISONE SOD SUCC 250MG INJ (MON) HYDROCORTISONE SODIU HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 250MG VIAL B 2.85 2.85 VIAL 0 VIAL MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 6804 ADRENALS 2026-04-01 IV 0 ADRENALS
40 26935 HYDROCORTISONE SOD SUCC 500MG INJ (CIR/AHI) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 50X500MG B 268.95 5.38 INJECTION 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 26937 HYDROCORTISONE SOD SUCC 500MG INJ ( (B) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 500MG VIAL B 4.57 4.5668 VIAL 0 VIAL MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 6804 ADRENALS 2024-04-01 2026-03-31 IV 0 ADRENALS
42 26937 HYDROCORTISONE SOD SUCC 500MG INJ (MON) HYDROCORTISONE SODIU HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 500MG VIAL B 3.89 3.89 VIAL 0 VIAL MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 6804 ADRENALS 2026-04-01 IV 0 ADRENALS