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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 67325 ULTRAVIST 300MG/ML INJ (BSP/AHI) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 34.31 34.31 INJECTION 0 VIAL BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 67325 ULTRAVIST 300MG/ML INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 50ML BQ 37.46 37.4585 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 67325 ULTRAVIST 300MG/ML INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 37.46 37.46 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2026-04-01 IV 0 ROENTGENOGRAPHY
40 6732T ULTRAVIST 300 INJ (BSP/COL) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 34.31 34.31 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6732T ULTRAVIST 300 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 50ML BQ 37.46 37.4585 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6732T ULTRAVIST 300 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 34.09 34.09 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 IV 0 ROENTGENOGRAPHY
40 6732U ULTRAVIST 300 INJ (BSP/COL) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 68.61 68.61 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6732U ULTRAVIST 300 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 100ML BQ 74.97 74.9714 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6732U ULTRAVIST 300 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 68.23 68.23 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 IV 0 ROENTGENOGRAPHY
40 6732V ULTRAVIST 300 INJ (BSP/AHI) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 68.61 68.61 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6732V ULTRAVIST 300 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 100ML BQ 74.97 74.9714 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6732V ULTRAVIST 300 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 74.97 74.97 BOTT 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2026-04-01 IV 0 ROENTGENOGRAPHY
40 6734Q ULTRAVIST 370 INJ (BSP/COL) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 46.76 46.76 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6734Q ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 50ML BQ 51.08 51.0773 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6734Q ULTRAVIST 370 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 51.27 51.27 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 IV 0 ROENTGENOGRAPHY
40 6734R ULTRAVIST 370 INJ (BSP/AHI) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 46.76 46.76 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 6734R ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 50ML BQ 51.08 51.0773 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY
42 6734R ULTRAVIST 370 INJ (BSP) IOPROMIDE IOPROMIDE ULTRAVIST 50ML BQ 56.32 56.32 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2026-04-01 IV 0 ROENTGENOGRAPHY
40 67351 ULTRAVIST 370 INJ (BSP/AHI) IOPROMIDE IOPROMIDE ULTRAVIST 100ML BQ 103.05 103.05 INJECTION 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
41 67351 ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) IOPROMIDE ULTRAVIST 100ML BQ 112.59 112.593 BOTT 7 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 IV 0 ROENTGENOGRAPHY