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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 6561D MESAGUT 400MG TAB (ARP/AHI) MESALAZINE MESALAZINE MESAGUT 30'S BQ 16.91 0.56 TABLET 0 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
42 6561D MESAGUT 400MG TAB (ARP) MESALAZINE MESALAZINE MESAGUT 30'S BQ 12.97 0.43 TAB 0 BLIS ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5632 GI PROKINETIC AGENTS 2026-04-01 ORAL 0 GI PROKINETIC AGENTS
40 6561G PENTASA 500MG TAB (FER/STO) MESALAZINE MESALAZINE PENTASA 50'S BQ 89.22 1.78 TABLET 0 TAB FER FERRING PHARMACEUTICALS LTD STO BRYDEN STOKES LTD 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Package Size Change oral 6 GASTROINTESTINAL DRUGS 2022-03-18
41 6561G PENTASA 500MG TAB (FER) MESALAZINE MESALAZINE PENTASA 50'S BQ 95.49 1.9099 TAB 0 BOX FER FERRING PHARMACEUTICALS LTD STO BRYDEN STOKES LTD 5632 GI PROKINETIC AGENTS 2024-04-01 2026-03-31 ORAL 0 GI PROKINETIC AGENTS
42 6561G PENTASA 500MG TAB (FER) MESALAZINE MESALAZINE PENTASA 50'S BQ 107.10 2.14 TAB 0 BLIS FER FERRING PHARMACEUTICALS LTD STO BRYDEN STOKES LTD 5632 GI PROKINETIC AGENTS 2026-04-01 ORAL 0 GI PROKINETIC AGENTS