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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 2593AD APO-SUCRALFATE 1G TAB (APO/COL) SUCRALFATE APO-SUCRALFATE 100'S A 45.72 0.46 TABLET 120 TAB APO APOTEX INC. COL COLLINS LTD 562832 GI PROTECTANTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
42 2593DU SUCRALFATE 1G TAB (MAT) SUCRALFATE SUCRALFATE 100'S A 83.81 0.84 TAB 120 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 562832 GI PROTECTANTS 2026-04-01 ORAL 6 GI PROTECTANTS