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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 90542 MENTHOL (GNT/AHI) MENTHOL MENTHOL 25KG B 5,861.39 234.46 0 KG GNT GENETHICS LTD AHI ARMSTRONG HEALTHCARE INC 9900 BULK DRUGS 2022-04-01 2024-03-31 TOPICAL 0 BULK DRUGS