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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 57618 STAFEN 1MG TAB (ARP/AHI) KETOTIFEN KETOTIFEN STAFEN 10X10 A 14.84 0.15 TABLET 60 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC B 481032 MAST CELL STABILISERS 2022-04-01 2024-03-31 Oral 6 RESPIRATORY TRACT AGENTS
41 57618 STAFEN 1MG TAB (ARP) KETOTIFEN KETOTIFEN STAFEN 10X10 A 8.62 0.0862 TAB 60 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC B 481032 MAST CELL STABILISERS 2024-04-01 2026-03-31 ORAL 6 MAST CELL STABILISERS
42 57618 STAFEN 1MG TAB (ARP) KETOTIFEN KETOTIFEN STAFEN 10X10 A 8.83 0.09 TAB 60 BLIS ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC B 481032 MAST CELL STABILISERS 2026-04-01 ORAL 6 MAST CELL STABILISERS
42 57629 KETOTIFEN 0.2MG/ML SYR (CIR) KETOTIFEN KETOTIFEN 60ML A 3.67 0.06 ML 100 BOTT CIR CIRON PHARMA CWS CAPSULE WHOLESALE B 481032 MAST CELL STABILISERS 2026-04-01 ORAL 6 MAST CELL STABILISERS
40 5762G KETOTIFEN MK 0.2MG/ML SYR (BON/COL) KETOTIFEN KETOTIFEN KETOTIFEN MK 100ML A 4.10 0.04 SYRUP 100 ML BON CORPORACION BONIMA COL COLLINS LTD B 481032 MAST CELL STABILISERS 2022-04-01 2024-03-31 Oral 6 RESPIRATORY TRACT AGENTS
41 5762K KETOTAG 0.2MG/ML SYR (GLP) KETOTIFEN KETOTIFEN KETOTAG 60ML A 4.0775 0.068 ML 100 BOTT GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE B 481032 MAST CELL STABILISERS 2024-04-01 2026-03-31 ORAL 6 MAST CELL STABILISERS