Displaying 1 - 7 of 7
  • Print
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 A3611 ARCALION 200MG TAB (SER/STO) SULBUTIAMINE SULBUTIAMINE ARCALION 20'S C 23.73 1.19 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2022-04-01 2024-03-31 Oral 0 UNCLASSIFIED THERAPEUTIC AGENTS
41 A3611 ARCALION 200MG TAB (SER) SULBUTIAMINE (C) SULBUTIAMINE ARCALION 20'S C 24.46 1.2232 TAB 0 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2024-04-01 2026-03-31 ORAL 0 UNCLASSIFIED THERAPEUTIC AGENTS
42 A3611 ARCALION 200MG TAB (SER) SULBUTIAMINE SULBUTIAMINE ARCALION 20'S C 24.46 1.22 TAB 0 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2026-04-01 ORAL 0 UNCLASSIFIED THERAPEUTIC AGENTS
40 A3612 ARCALION 200MG TAB (SER/COL) SULBUTIAMINE SULBUTIAMINE ARCALION 20'S C 23.73 1.19 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2022-04-01 2024-03-31 Oral 0 UNCLASSIFIED THERAPEUTIC AGENTS
41 A3612 ARCALION 200MG TAB (SER) SULBUTIAMI (C) SULBUTIAMINE ARCALION 20'S C 24.46 1.2232 TAB 0 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2024-04-01 2026-03-31 ORAL 0 UNCLASSIFIED THERAPEUTIC AGENTS
42 A3612 ARCALION 200MG TAB (SER) SULBUTIAMI SULBUTIAMINE ARCALION 20'S C 24.46 1.22 TAB 0 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2026-04-01 ORAL 0 UNCLASSIFIED THERAPEUTIC AGENTS
40 A3613 SULBUTIAMINE 200MG TAB (KWA/ATB) SULBUTIAMINE SULBUTIAMINE 20'S C 12.23 0.61 TABLET 0 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2022-04-01 2024-03-31 Oral 0 UNCLASSIFIED THERAPEUTIC AGENTS