Displaying 1 - 10 of 10
| 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 | 2551C | FLEET ENEMA ADULT 7G | 19G (FLE/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHATE | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | FLEET ENEMA ADULT | 133ML | A | 2.23 | 2.23 | 2 | ENMA | FLE | C.B. FLEET & CO. INC., | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2022-04-01 | 2024-03-31 | RECTAL | 6 | GASTROINTESTINAL DRUGS | 2021-12-17 | |||||
| 41 | 2551C | FLEET ENEMA ADULT 7G|19G ENEMA (FLE) SODIUM BIPHOSPHATE|SODI | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | FLEET ENEMA ADULT | 133ML | A | 2.94 | 2.9358 | ENMA | 2 | BOX | FLE | C.B. FLEET & CO. INC., | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2024-04-01 | 2026-03-31 | RECTAL | 6 | CATHARTICS AND LAXATIVES | |||||
| 41 | 2551E | QC ENEMA ADULT 7G|19G ENEMA (QUC) SODIUM BIPHOSPHATE|SODIUM | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | QC ENEMA ADULT | 133ML | A | 3.56 | 3.561 | ENMA | 2 | BOX | QUC | QUALITY CHOICE | RXP | RX PRO INC | 5612 | CATHARTICS AND LAXATIVES | 2024-04-01 | 2026-03-31 | Rectal | 6 | CATHARTICS AND LAXATIVES | |||||
| 42 | 2551E | QC ENEMA ADULT 7G|19G ENEMA (QUC) SODIUM BIPHOSPHATE|SODIUM | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | QC ENEMA ADULT | 133ML | A | 3.56 | 3.56 | BOTT | 2 | BOX | QUC | QUALITY CHOICE | RXP | RX PRO INC | 5612 | CATHARTICS AND LAXATIVES | 2026-04-01 | RECTAL | 6 | CATHARTICS AND LAXATIVES | ||||||
| 40 | 2551F | ENEMA-LAX ADULT 7G | 19G ENEMA (LAF/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHATE | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | ENEMA-LAX ADULT | 133ML | A | 3.89 | 3.89 | ENEMA | 2 | ENMA | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2022-04-01 | 2024-03-31 | Change Local Agent | Oral | 6 | GASTROINTESTINAL DRUGS | 2022-02-03 | |||
| 42 | 2551F | ENEMA-LAX ADULT 7G|19G ENEMA (LAF) SODIUM BIPHOSPHATE|SODIUM | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | ENEMA-LAX ADULT | 133ML | B | 8.83 | 8.83 | BOTT | 2 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2026-04-01 | ORAL | 6 | CATHARTICS AND LAXATIVES | ||||||
| 40 | 25527 | FLEET ENEMA PAED 3.5G | 9.5G (FLE/AHI) SODIUM | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | FLEET ENEMA PAED | 66ML | B | 5.79 | 5.79 | 0 | ENMA | FLE | C.B. FLEET & CO. INC., | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2022-04-01 | 2024-03-31 | RECTAL | 0 | GASTROINTESTINAL DRUGS | 2021-12-17 | |||||
| 41 | 25527 | FLEET ENEMA PAED 3.5G|9.5G (FLE) SODIUM | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | FLEET ENEMA PAED | 66ML | A | 3.26 | 3.262 | ENMA | 2 | BOX | FLE | C.B. FLEET & CO. INC., | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2024-04-01 | 2026-03-31 | RECTAL | 6 | CATHARTICS AND LAXATIVES | |||||
| 40 | 25528 | ENEMA-LAX CHILD 9.5G | 3.5G ENEMA (LAF/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHAT More ... | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | ENEMA-LAX CHILD | 66ML | A | 3.89 | 3.89 | ENEMA | 2 | ENMA | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2022-04-01 | 2024-03-31 | Change Local Agent | Oral | 6 | GASTROINTESTINAL DRUGS | 2022-02-03 | |||
| 42 | 25528 | ENEMA-LAX CHILD 9.5G|3.5G ENEMA (LAF) SODIUM BIPHOSPHATE|SOD | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | ENEMA-LAX CHILD | 66ML | A | 8.16 | 8.15 | BOTT | 2 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2026-04-01 | ORAL | 6 | CATHARTICS AND LAXATIVES | ||||||