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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 7911R NORGESIC 35MG | 500MG TAB (PMA/AHI) ORPHENADRINE | PARACETAMOL ORPHENADRINE|PARACETAMOL NORGESIC 10'S C 7.07 0.71 TABLET 0 TAB PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 122092 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 7911R NORGESIC 35MG|500MG TAB (PMA) ORPHENADRINE|PARACETAMOL (C) ORPHENADRINE|PARACETAMOL NORGESIC 10'S C 8.15 0.8155 TAB 0 BOX PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 122092 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS