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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 08234 ISOLIN 2MG/ML INJ (SLS/AHI) ISOPRENALINE ISOPRENALINE ISOLIN 5X1ML BQ 37.92 7.58 INJECTION 0 VIAL SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 121208 BETA ADRENERGIC AGONIST 2022-04-01 2024-03-31 IV 0 AUTONOMIC DRUGS
41 08234 ISOLIN 2MG/ML INJ (SLS) ISOPRENALINE (BQ) ISOPRENALINE ISOLIN 5X1ML BQ 37.92 7.5841 VIAL 1 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 121208 BETA ADRENERGIC AGONIST 2024-04-01 2026-03-31 IV 0 BETA ADRENERGIC AGONIST