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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 3081Y IMMUNOREL 5% INJ (RLS/AHI) IMMUNOGLOBULIN IMMUNOGLOBULIN HUMAN IMMUNOREL 100ML BQ 657.29 657.29 INJECTION 0 BOTT RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 3081Y IMMUNOREL 5% INJ (RLS) IMMUNOGLOBUL (BQ) IMMUNOGLOBULIN HUMAN IMMUNOREL 100ML BQ 807.34 807.3422 BOTT 0 BOTT RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS
42 3081Y IMMUNOREL 5% INJ (RLS) IMMUNOGLOBUL IMMUNOGLOBULIN HUMAN IMMUNOREL 100ML BQ 807.34 807.34 BOTT 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 IV 0 SERUMS
40 30827 PRIVIGEN 10% INJ (CSL/AHI) IMMUNOGLOBULIN IMMUNOGLOBULIN HUMAN PRIVIGEN 50ML BQ 951.41 951.41 INJECTION 0 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 30827 PRIVIGEN 10% INJ (CSL) IMMUNOGLOBULIN (BQ) IMMUNOGLOBULIN HUMAN PRIVIGEN 50ML BQ 883.46 883.4553 BOTT 50 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS
40 30828 PRIVIGEN 10% INJ (CSL/AHI) IMMUNOGLOBULIN IMMUNOGLOBULIN HUMAN PRIVIGEN 100ML BQ 1,413.53 1,413.53 INJECTION 0 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2022-04-01 2022-05-10 IV 0 SERUMS, TOXOIDS AND VACCINES 2022-03-29
41 30828 PRIVIGEN 10% INJ (CSL) IMMUNOGLOBULIN (BQ) IMMUNOGLOBULIN HUMAN PRIVIGEN 100ML BQ 1766.91 1766.9106 BOTT 50 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS
42 3082B IMMUNOGLOBULIN 10% INJ (INP) IMMUNOGLOBULIN HUMAN IMMUNOGLOBULIN 50ML VIAL BQ 538.83 538.83 VIAL 0 VIAL INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 IV 0 SERUMS
42 3082C NORMOGLOBIN 10% INJ (INC) IMMUNOGLOBULIN HUMAN IMMUNOGLOBULIN HUMAN NORMOGLOBIN 50ML VIAL BQ 615.86 615.86 VIAL 0 VIAL INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 IV 0 SERUMS
42 3091J TETAGAM P 250IU/ML PREFIL SYRN (CSL) IMMUNOGLOBULIN HUMAN TETANUS IMMUNOGLOBULIN HUMAN TETAGAM P 4X1ML PFS B 108.73 108.73 PFS 0 PFS CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 Add to Contract IM 0 SERUMS 2025-11-10