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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
41 7421D LIDOCAINE|PRILOCAINE 2.5%|2.5% CR (AKI) (BQ) LIDOCAINE|PRILOCAINE LIDOCAINE|PRILOCAINE 30G BQ 116.45 116.453 TUBE 1 BOX AKI AKORN INC. AHI ARMSTRONG HEALTHCARE INC 7200 LOCAL ANESTHETICS 2024-04-01 2026-03-31 TOPICAL 0 LOCAL ANESTHETICS