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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 6251C POTASSIUM PHOSPHATE 3MMOL/ML INJ (LDP/AHI) POTASSIUM PHOSPHATE POTASSIUM PHOSPHATE 15ML BQ 11.74 11.74 INJECTION 0 VIAL LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 4012 REPLACEMENT THERAPY 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 6251D POTASSIUM PHOSPHATE 3MMOL/ML INJ (KWA) (BQ) POTASSIUM PHOSPHATE POTASSIUM PHOSPHATE 15ML VIAL BQ 6.93 6.9317 VIAL 0 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY