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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 10415 PROTAMINE SULPHATE 10MG/ML INJ (SLS/AHI) PROTAMINE SULPHATE PROTAMINE SULPHATE 25X5ML B 235.27 9.41 INJECTION 0 AMP SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 202808 ANTIHEPARIN 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 10415 PROTAMINE SULPHATE 10MG/ML INJ (SLS) (B) PROTAMINE SULPHATE PROTAMINE SULPHATE 25X5ML B 235.27 9.4108 AMP 20 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 202808 ANTIHEPARIN 2024-04-01 2026-03-31 IV 0 ANTIHEPARIN