Displaying 1 - 20 of 20
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 0012ER GLENCET 5MG TAB (GLP/ALI) LEVOCETIRIZINE LEVOCETIRIZINE GLENCET 30'S C 6.80 0.23 TABLET 0 TAB GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2022-03-22 Delete from contract Oral 0 ANTIHISTAMINICS 2022-03-22
41 0211AT MEROPENEM 500MG INJ (MON) (BQ) MEROPENEM MEROPENEM 10X500MG BQ 9.49 0.9487 VIAL 42 BOX MON MONTAGE PHARMACEUTICALS ALI ALL HEALTH INC 08120708 CARBAPENEMS 2024-04-01 2026-03-31 IV 2 CARBAPENEMS
40 3701AW TRUE METRIX (HOM/ALI) DIAGNOSTIC BLOOD GLUC DIAGNOSTIC BLOOD GLUCOSE TRUE METRIX 50'S A 30.04 30.04 GLUCOSE STRI 1 PACK HOM NIPRO DIAGNOSTICS ALI ALL HEALTH INC B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
40 4253P SUPIROCIN 2% OINT (GLP/ALI) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 5.44 5.44 OINT 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840404 ANTIBIOTICS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
41 4291AK VANCOMYCIN 500MG INJ (HET) (BQ) VANCOMYCIN VANCOMYCIN 10ML BQ 4.08 4.0775 VIAL 56 VIAL HET HETERO DRUGS LTD ALI ALL HEALTH INC 08122816 GLYCOPEPTIDES 2024-04-01 2026-03-31 IV 0 GLYCOPEPTIDES
40 5231DU CELAMINA 1% CR (GLP/ALI) CICLOPIROX OLAMINE CICLOPIROX OLAMINE CELAMINA 20G A 6.80 6.80 CREAM 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5232AZ CANDID 1% EAR DR (GLP/ALI) CLOTRIMAZOLE CLOTRIMAZOLE CANDID 15ML A 6.80 6.80 EAR DROP 1 BOTT GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract OTIC 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5232ZA CANDID MOUTH PAINT 1% SOLN (GLP/ALI) CLOTRIMA CLOTRIMAZOLE CANDID MOUTH PAINT 20ML A 6.80 6.80 SOLUTION 2 BOTT GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5233AD CANDID 1% PWDR (GLP/ALI) CLOTRIMAZOLE CLOTRIMAZOLE CANDID 100G A 7.61 7.61 POWDER 1 BOTT GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5561CM CANDID V 2% VAG CR (GLP/ALI) CLOTRIMAZOLE CLOTRIMAZOLE CANDID V 30G A 6.80 6.80 VAGINAL CREA 1 PACK GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 081408 AZOLES 2022-04-01 2022-03-22 Delete from contract VAGINAL 0 ANTI-INFECTIVE AGENTS 2022-03-22
41 6821W AMIODARONE 50MG/ML INJ (MON) (B) AMIODARONE AMIODARONE 5X3ML B 3.26 0.6524 VIAL 50 BOX MON MONTAGE PHARMACEUTICALS ALI ALL HEALTH INC 240404 ANTIARRHYTHMIC AGENTS 2024-04-01 2026-03-31 IV 0 ANTIARRHYTHMIC AGENTS
41 7471AD FLUPENTHIXOL 20MG/ML INJ (MON) (B) FLUPENTHIXOL FLUPENTHIXOL 10X1ML B 5.33 0.5328 AMP 6 BOX MON MONTAGE PHARMACEUTICALS ALI ALL HEALTH INC 28160824 PHENOTHIAZINES 2024-04-01 2026-03-31 IV 6 PHENOTHIAZINES
41 7472AB FLUPHENAZINE 25MG/ML INJ (MON) (B) FLUPHENAZINE FLUPHENAZINE 10ML B 6.55 6.5512 VIAL 3 VIAL MON MONTAGE PHARMACEUTICALS ALI ALL HEALTH INC 28160824 PHENOTHIAZINES 2024-04-01 2026-03-31 IM 6 PHENOTHIAZINES
41 7726CS PIPERACILLIN|TAZOBACTAM 4G|0.5G INJ (MON) (BQ) PIPERACILLIN|TAZOBACTAM PIPERACILLIN|TAZOBACTAM 4.5G VIAL BQ 4.62 4.6212 VIAL 0 VIAL MON MONTAGE PHARMACEUTICALS ALI ALL HEALTH INC 081216 PENICILLINS 2024-04-01 2026-03-31 IV 0 PENICILLINS
40 A3937 COMBIWAVE 125/25 INHR (GLP/ALI) FLUTICASONE/S FLUTICASONE|SALMETEROL COMBIWAVE 120 DOSES C 27.18 27.18 INHALER 0 INHR GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2022-03-22 Delete from contract ORAL INHALATION 0 RESPIRATORY TRACT AGENTS 2022-03-22
40 A3965 COMBIWAVE 250MCG | 25MCG INHR (GLP/ALI) FLUTICASONE | SALMETEROL FLUTICASONE|SALMETEROL COMBIWAVE 150 DOSES C 32.62 32.62 INHALER 0 INHR GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2022-03-22 Delete from contract ORAL INHALATION 0 RESPIRATORY TRACT AGENTS 2022-03-22
41 A681HQ EFAVIRENZ|EMTRICITABINE|TENOFOVIR 600MG|200MG|300MG TAB (HET (BL) EFAVIRENZ|EMTRICITABINE|TENOFOVIR EFAVIRENZ|EMTRICITABINE|TENOFOVIR 30'S BL 46.76 1.5585 TAB 60 BOTT HET HETERO DRUGS LTD ALI ALL HEALTH INC 081892 ANTIVIRALS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTIVIRALS, MISCELLANEOUS
41 A681HV EMTRICITABINE|TENOFOVIR 200MG|300MG CAP (HET) (BL) EMTRICITABINE|TENOFOVIR EMTRICITABINE|TENOFOVIR 60'S BL 46.76 0.7793 CAP 60 BOTT HET HETERO DRUGS LTD ALI ALL HEALTH INC 081892 ANTIVIRALS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTIVIRALS, MISCELLANEOUS
40 A9632 DERIVA 0.1% CR (GLP/ALI) ADAPALENE ADAPALENE DERIVA 15G C 16.31 16.31 CREAM 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 8428 KERATOLYTICS 2022-04-01 2022-03-22 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 A9634 DERIVA 0.1% GEL (GLN/ALI) ADAPALENE ADAPALENE DERIVA 45G C 29.90 29.90 GEL 0 TUBE GLN GLAND ALI ALL HEALTH INC 8428 KERATOLYTICS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS