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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 2931W VASOPRESSIN 20U/ML INJ (SLS/AHI) VASOPRESSIN VASOPRESSIN 5X1ML BQ 92.69 18.54 INJECTION 0 VIAL SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6828 PITUITARY 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 2931W VASOPRESSIN 20U/ML INJ (SLS) (BQ) VASOPRESSIN VASOPRESSIN 5X1ML BQ 92.69 18.539 VIAL 6 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6828 PITUITARY 2024-04-01 2026-03-31 IV 0 PITUITARY
42 2931W VASOPRESSIN 20U/ML INJ (SLS) VASOPRESSIN VASOPRESSIN 5X1ML BQ 92.69 18.54 VIAL 6 AMP SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6828 PITUITARY 2026-04-01 IV 0 PITUITARY
40 2931Y VASMED 20U/ML INJ (UBI/RXP) VASOPRESSIN VASOPRESSIN VASMED 1ML AMP BQ 10.47 10.47 INJECTION 0 AMP UBI UNITED BIOTECH (P) LIMITED RXP RX PRO INC 6828 PITUITARY 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
42 2931Z VASOPRESSIN 20U/ML INJ (FSB) VASOPRESSIN VASOPRESSIN 5X1ML BQ 64.10 12.82 AMPP 6 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 6828 PITUITARY 2026-04-01 Add to Contract IV/IM/SC 0 PITUITARY 2026-03-05