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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 0621B MERCAPTOPURINE 50MG TAB (SLS/AHI) MERCAPTOPURINE MERCAPTOPURINE 30'S A 45.64 1.52 TABLET 60 TAB SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
41 0621B MERCAPTOPURINE 50MG TAB (SLS) MERCAPTOPURINE MERCAPTOPURINE 30'S A 45.64 1.5214 TAB 60 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC B 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 ORAL 6 ANTINEOPLASTICS
40 0621C PURINETHOL 50MG TAB (ASG/STO) MERCAPTOPURINE MERCAPTOPURINE PURINETHOL 25'S A 104.38 4.18 TABLET 60 TAB ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
41 0621C PURINETHOL 50MG TAB (ASG) MERCAPTOP (C) MERCAPTOPURINE PURINETHOL 25'S C 107.51 4.3004 TAB 60 BOX ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD B 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 ORAL 6 ANTINEOPLASTICS