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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
41 1691B THIORIDAZINE 10MG TAB (MAT) THIORIDAZINE THIORIDAZINE 100'S A 221.9 2.219 TAB 360 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2024-04-01 2026-03-31 ORAL 6 PHENOTHIAZINES
42 1691B THIORIDAZINE 10MG TAB (MAT) THIORIDAZINE THIORIDAZINE 100'S A 221.90 2.22 TAB 360 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2026-04-01 ORAL 6 PHENOTHIAZINES
41 1692M THIORIDAZINE 25MG TAB (MAT) THIORIDAZINE THIORIDAZINE 100'S A 312.06 3.1206 TAB 360 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2024-04-01 2026-03-31 ORAL 6 PHENOTHIAZINES
42 1692M THIORIDAZINE 25MG TAB (MAT) THIORIDAZINE THIORIDAZINE 100'S A 312.06 3.12 TAB 360 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2026-04-01 ORAL 6 PHENOTHIAZINES
42 1693C THIORIDAZINE 50MG TAB (MAT) THIORIDAZINE THIORIDAZINE 1000'S A 364.42 0.36 TAB 300 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2026-04-01 ORAL 6 PHENOTHIAZINES